Is taking MAC medications while planning for pregnancy safe?

Question

Hello doctor,

My aunt has MAC (Mycobacterium avium complex) lung disease and has been on long-term antibiotics for the past year. She is in her late 30s and wants to try for a baby soon, but we are concerned about the safety of her medications during pregnancy.

Could she stop treatment temporarily, or would that worsen her lung condition?
Would pregnancy put extra strain on her breathing and make her more prone to flare-ups?
Is it safe for her to use hormonal contraception until she is ready to conceive, or could that interact with her antibiotics?
If she undergoes IVF (in vitro fertilization), are there any risks related to her lung health?
Also, can breastfeeding transmit MAC to the baby, or is it completely safe?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Mycobacterium avium complex (MAC) lung disease often requires long-term, multi-drug antibiotic therapy commonly including Macrolides (like Azithromycin or Clarithromycin), Ethambutol, and Rifamycins, which can pose potential risks to a developing fetus, especially if taken during early pregnancy.

Stopping treatment abruptly or prematurely is generally not advisable, as it may lead to disease progression, relapse, or antibiotic resistance. Still, timing and regimen adjustments can sometimes be planned under the close supervision of both her pulmonologist and a maternal–fetal medicine specialist.

Pregnancy increases oxygen demand and can put extra strain on the lungs, which may worsen symptoms if the infection is not well-controlled beforehand. Hormonal contraception is generally safe in women with MAC. Still, Rifampin and other Rifamycins can reduce the effectiveness of oral contraceptives, so non-hormonal or barrier methods or higher-dose or alternative hormonal methods should be discussed with her doctor.

IVF (in-vitro fertilization) is not contraindicated purely because of MAC (Mycobacterium avium complex) lung disease. Still, her lung function should be optimized before undergoing the hormonal and physical demands of the procedure, and both the fertility and pulmonary teams should coordinate care.

As for breastfeeding, MAC is not known to be transmitted through breast milk; the main concern would be the presence of antibiotics in the milk and potential side effects for the infant, so medication safety during lactation should be reviewed in advance. Careful pre-pregnancy planning, infection control, and lung monitoring will be key to a safer outcome.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.