Amikacin Liposome Inhalation Suspension (ALIS) as part of the initial regimen in the treatment of non-tuberculous mycobacteria (NTM) treatment

Abstract

Managing non-tuberculous mycobacterial (NTM) lung disease poses challenges due to the extended treatment duration and frequent occurrence of adverse effects. Amikacin Liposome Inhalation Suspension (ALIS) is a liposomal form of amikacin, delivered through inhalation directly to the lungs. Recently published guidelines now recommend the use of (ALIS) as a component of the treatment regimen for Mycobacterium avium complex (MAC) lung disease in cases of refractory disease. However, no data exist supporting its inclusion in the initial regimen. In this case report, we present a patient with a newly diagnosed M. intracellulare infection and extensive bilateral disease who received ALIS due to the precarious use of parenteral amikacin. A 64-year-old female patient, with impaired kidney function due to kidney cancer and nephrectomy presented with cough and malaise over the last three months. The CT scan performed demonstrated multiple bilateral nodules and infiltrates, as well as bronchiectasis. A bronchoscopy was conducted and M.intracellulare was isolated from the bronchoalveolar lavage. Given the extensive nature of the disease, even in the absence of a cavity and given the impaired kidney function, the patient was administered a therapy regimen including azithromycin, rifampicin, ethambutol, and ALIS. The patient benefited the most of the treatment in terms of clinical, microbiological and imaging aspects while avoiding serious adverse effects due to amikacin. It is necessary to always consider the best treatment for the patient even beyond established guidelines in order to achieve the best outcome. ALIS is a promising new treatment that needs to be studied further.