Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto
Aznar, Maria Luisa (Hospital Universitari Vall d'Hebron)
Marras, Theodore K. (University Health Network and Sinai Health System. Joint Division of Respirology, Department of Medicine)
Elshal, Ahmed Said (Gastroenterology Department, National Hepatology and Tropical Medicine Institute)
Mehrabi, Mahtab (University Health Network and Sinai Health System. Joint Division of Respirology, Department of Medicine)
Brode, Sarah K. (West Park Healthcare Centre)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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. 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. We 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. A 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. Patients 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Amikacin ; NTM lung disease ; Nontuberculous mycobacteria
Publicat a:	BMC Pharmacology & Toxicology, Vol. 20 (june 2019) , ISSN 2050-6511

DOI: 10.1186/s40360-019-0302-1
PMID: 31159865

9 p, 602.2 KB

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