Abstract
BackgroundTreatment guidelines suggest either a low-dose or high-dose approach when prescribing amikacin for nontuberculous mycobacterial pulmonary disease (NTM PD), but data supporting the low-dose approach are limited. The purpose of this study was to describe the safety and efficacy of the use of a low-dose of intravenous amikacin in a cohort of patients with NTM PD.MethodsWe retrospectively reviewed all patients with NTM PD who received amikacin at our institution between July 1, 2003 and February 28, 2017. Demographics, clinical, microbiological and radiological data, indication and dose of amikacin, and adverse drug effects were recorded.ResultsA total of 107 patients received a regimen containing amikacin for a median (IQR) of 7 (4–11) months. Seventy (65.4%) were female and the mean age (SD) was 58.3 (14.9) years. Amikacin was started at a median dose of 9.9 (2.5) mg/kg/day. Ototoxicity was observed in 30/77 (39%) patients and it was related to female sex (OR 4.96, 95%CI 1.24–19.87), and total dose of amikacin per bodyweight (OR 1.62, 95%CI 1.08–2.43). Patients of East Asian ethnicity were less likely to develop ototoxicity (0.24, 95%CI 0.06–0.95). Out of 96 patients who received amikacin for more than 3 months, 65 (67.7%) experienced symptom improvement and 30/62 (49.2%) converted their sputum to culture negative within a year.ConclusionsPatients with NTM PD treated with low-dose intravenous amikacin frequently developed ototoxicity, which was associated with female sex, and total dose of amikacin per bodyweight. Physicians should carefully consider dose, treatment duration, and long term prognosis in balancing risks and benefits of intravenous amikacin in NTM PD.
Highlights
Treatment guidelines suggest either a low-dose or high-dose approach when prescribing amikacin for nontuberculous mycobacterial pulmonary disease (NTM Nontuberculous mycobacteria (NTM) pulmonary disease (PD)), but data supporting the low-dose approach are limited
Data suggest that a high Minimum Inhibitory Concentration (MIC) for amikacin is associated with worse clinical outcomes in Mycobacterium avium complex (MAC)-NTM pulmonary disease (PD) [7, 8], formal recommendations have not yet been developed for MAC-PD
Forty-four (41.1%) patients had previously been treated for nontuberculous mycobacterial pulmonary disease (NTM PD) and one patient had received amikacin previously at another institution
Summary
Treatment guidelines suggest either a low-dose or high-dose approach when prescribing amikacin for nontuberculous mycobacterial pulmonary disease (NTM PD), but data supporting the low-dose approach are limited. Data suggest that a high Minimum Inhibitory Concentration (MIC) for amikacin is associated with worse clinical outcomes in MAC-PD [7, 8], formal recommendations have not yet been developed for MAC-PD. Treatment guidelines suggest either a low-dose or high-dose approach when prescribing amikacin for NTM PD, data supporting the low-dose approach are scarce. Despite of all these limitations, amikacin remains one of the most potent drugs for the treatment of NTM PD, and data on its risks and benefits are critical
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