Patients diagnosed with NTM disease were prescribed significantly more antibiotics across most classes compared to matched comparators up to three years prior to diagnosis. Increased antibiotic use could be a risk factor for NTM disease, by disturbing the normal microbiome. However, increased antibiotic exposure likely also reflects diagnostic difficulties or higher comorbidity burden necessitating antibiotic treatment. Clinicians should consider NTM disease when experiencing frequent antibiotic use, especially in patients with additional risk factors. Further studies are needed to elucidate if pre-diagnosis exposure to specific antibiotics is associated with antibiotic resistance, or outcomes, of NTM disease.