In addition to the mac, i also had massiliense which is another ntm and not very successful to treatment. Considering potential toxicity, intolerance, and costs of daily therapy with macrolidebased regimens, current guidelines recommended three times weekly intermittent therapy with a macrolide clarithromycin 1,000 mg or azithromycin 500 mg, rifampin 600 mg, and ethambutol at 25 mgkg for the initial treatment of noncavitary nodular. It should be given as an adjunct to ethambutol, rifamycin, and macrolide. Amikacin sulfate amikacin sulfate dose, indications. Unfortunately, i was being treated for 2 ntm pathogens mac and massiliense. I would not be concerned about the numbers if you are having weekly amikacin trough levels drawn. Current standard treatment of mac lung infection involves three drugs biaxin, ethambutol, and rifampin taken three times a week for a minimum of 1518 months.
Preliminary results of bedaquiline as salvage therapy for. I took it 5x per week for three months, then 3x per week for three months. Mar 31, 2016 considering potential toxicity, intolerance, and costs of daily therapy with macrolidebased regimens, current guidelines recommended three times weekly intermittent therapy with a macrolide clarithromycin 1,000 mg or azithromycin 500 mg, rifampin 600 mg, and ethambutol at 25 mgkg for the initial treatment of noncavitary nodular. The most active parenteral agents include amikacin 1015 mgkgday or 1525 mg kg thrice weekly, cefoxitin 200 mg kgday up to 12 gday in divided doses, imipenem 5001,000 mg 2 to four times daily, and tigecycline 50 mg once or twice daily 65. Eleven patients 2 with mdr tuberculosis who were treated with 15 mgkg amikacin showed a median range backcalculated c max, iv of 46 2654 mgl. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body. Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. It is used either by injection into a vein or muscle amikacin, like other aminoglycoside antibiotics, can cause hearing loss, balance. Nontuberculous mycobacteria ntm can infect almost any organ in the body, thus, signs and symptoms will vary depending on the site of infection. Jan 25, 2020 amikacin is recommended as part of a multiantibiotic treatment regimen of mycobacterium avium complex mac in patients with cystic fibrosis in certain situations floto 2016. Streptomycin, kanamycin, and amikacin remain important drugs for treating diseases caused by mycobacterium tuberculosis mtb, mycobacterium avium complex mac, and other nontuberculous mycobacteria ntm 1. Because intermittent therapy was not popular in korea during this study period, many patients with nodular bronchiectatic disease were still receiving daily antibiotic therapy. Dec 02, 2019 10 to 15 mgkg iv once or 25 mgkg iv 3 times a week use. I also had to have a weekly hearing test which took hours each week.
Following once daily inhalation of 590 mg arikayce in mycobacterium avium complex mac patients, sputum concentrations at 1 to 4 hours postinhalation were 1720, 884, and 0 mcgg at 1, 3, and 6 months, respectively. Amikacin is an antibiotic used for a number of bacterial infections. Among the five patients with coinfection of mac, three showed. For other agents less frequent dosing may have inconsistent effects on immunosuppressive agents and is not usually recommended as initially therapy or for patients with cavitary lung disease. Out of 96 patients who received amikacin for more than 3 months. Amikacin epikacin uses, side effects, dose and brands. Mycobacterium avium complex mac consists of two species. Amikacin therapeutic drug monitoring interpretive notes antibiotic assays version 2, february 2009. The first three drugs are pillscapsules and may be given daily or three times weekly mondaywednesdayfriday.
Th e macrolide was omitted if the mac isolate was macrolide resistant. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body weight tbw. Current opinions in the treatment of pulmonary nontuberculous. The patient had never been on amikacin but had been on the latter two drugs at the same doses for the. The target csf levels of amikacin should be 10 to 20 times that of the mic of the organism. The study population consisted of patients with ntm. Can be dosed multiple times per day, once daily or a few times per week iv. A recent cohort study showed that a threetimesweekly intermittent therapy in patients with previously treated noncavitary nodular bronchiectatic macpd achieved a high sputum culture conversion rate that was comparable with that of daily therapy 82% vs. Drugresistant tuberculosis curry international tuberculosis center.
Past studies have shown the potential for sporadic development of amikacin resistance in mac among patients on inhaled amikacin. Has only been studied for refractory mac lung disease. Detailed amikacin dosage information for adults, the elderly and children. For patients with fibrocavitary mac lung disease or severe nodularbronchiectactic disease. Liposomeencapsulatedamikacin therapy of mycobacterium avium complex infection in beige mice. Doses were adjusted to achieve target serum concentrations. The efficacy, safety, and feasibility of inhaled amikacin for. Eightyseven patients with tuberculosis or non tuberculous mycobacterial infections were prospectively randomized by drug to receive 15 mgkg per day or 25 mgkg 3 times per week of intravenous streptomycin, kanamycin, or amikacin.
Aminoglycoside dosing and monitoring recommendations. Treatment of mac for most patients with nodularbronchiectatic disease includes a three times weekly regiment of clarithromycin or azithromycin, rifampin, and ethambutol. It is a very powerful drug with many bad side effects. Third or fourth drug option as an alternative treatment in patients with disseminated mycobacterium avium complex mac. High variability in amikacin concentrations were observed cv% 100%. Slowly growing nontuberculous mycobacterial infections. Therapeutic drug monitoring in the treatment of mycobacterium aviumcomplex lung disease wonjung koh 1, byeongho jeong, kyeongman jeon1, sooyoun lee2, and sung jae shin3 1division of pulmonary and critical care medicine, department of medicine and 2department of laboratory medicine and genetics, samsung medical center, sungkyunkwan university school of medicine, seoul, korea. New therapies, including clofazimine, inhaled amikacin, and. Amikacin liposome is considered experimental, investigational or unproven for any other use including. Therefore achieving a peak between 2030mgl will be.
Patients with macrolidesusceptible mac were treated with azithromycin, 500 mg given three times weekly tiw. In multidrug regimens, including an intravenous aminoglycoside e. Should consider three times weekly amikacin or streptomycin iv early in therapy. The patient was started on three times weekly 300 mg rifabutin and 35 mg ethambutolkg of body weight see fig. Multidrugresistant tuberculosis mdrtb is an increasing global problem. Mycobacterium avium complex mac mycobacterium avium. Clarithromycin biaxin clarithromycin belongs to a class of drugs known as macrolides. Patients with renal dysfunction andor those who are older may require 15 mgkg given 3 times a week. Amikacin is not absorbed orally and is given by either intramuscular or slow intravenous injection either once or twice daily or, in severe infections, three times daily. The pathogen mycobacterium avium complex mac is the most common cause of. Amikacin works most effectively the higher the concentration of the drug exceeds the mic of the target organism. This includes joint infections, intraabdominal infections, meningitis, pneumonia, sepsis, and urinary tract infections. To use nomogram for amikacin, divide the actual serum level of amikacin in half.
Amikacin inhalation as salvage therapy for refractory. Eleven 2 with mdr tuberculosis patients who were treated with 25 mgkg amikacin 3 times a week showed backcalculated c max of 79 5498 mgl. The tiw regimen consists of azithromycin 500 to 600 mg or. Pharmacotherapy approaches in nontuberculous mycobacteria. Griffith, 2007 for those with nodularbronchiectatic disease or with fibrocavitary disease who cannot tolerate daily treatment, a three times weekly tiw, three drug regimen is recommended. There is no published study of the side effects or effectiveness of amikacin when given in this manner. Amikacin works by blocking the function of the bacterias 30s ribosomal subunit, making it unable to produce proteins. Streptomycin, kanamycin, and amikacin remain important drugs for treating diseases caused by mycobacterium tuberculosis mtb, mycobacterium avium complex mac, and other nontuberculous mycobacteria ntm 14. Aminoglycoside dosing guidelines for adults necessary patient information for dosing ideal body weight ibw. Mac macrolide azithromycin 12 mo 56% to 85% ethambutol rifamycin m. Pdr drug summaries are concise pointofcare prescribing, dosing and administering information to help phsyicans more efficiently and accurately prescribe in their practice pdr s drug summaries are available free of charge and serve as a great resource for us based mds, dos, nps and pas in patient practice. Streptomycin, kanamycin, and amikacin can be administered either daily or 3 times weekly without affecting the likelihood of toxicity.
Streptomycin was administered intramuscularly in some patients with severe. Treatment of pulmonary infections caused by mycobacterium avium complex mac and mycobacterium kansasii involves multidrug oral therapy with a macrolide azithromycin or clarithromycin, ethambutol, and a rifamycin rifampin or rifabutin. Myambutol ethambutol hydrochloride dose, indications. Eightyseven patients with tuberculosis or nontuberculous mycobacterial infections were prospectively randomized by drug to receive 15 mgkg per day or 25 mgkg 3 times per week of intravenous streptomycin, kanamycin, or amikacin. Clinical efficacy and safety of multidrug therapy including. Average dosage is 250 mg 2 to 4 times weekly for 6 months. Ivs 3 times a week for non aids mac mai lung disease. Daily regimen of clarithromycin 500mg or azithromycin 250mg, rifampin 600mg or rifabutin 150300mg and ethambutol 15mgkg. However, when taken for extended periods, these can cause nephrotoxicity, neurotoxicity and irreversible ototoxicity 1, 2. For the full time i was on the amikacin i had a hearing test weekly.
The general dosing range for daily iv amikacin is 7 to 14mg. She might add amikacin or streptomycin three times a week early in your treatment. The patient had never been on amikacin but had been on the latter two drugs at the same doses for the first 5 years. In addition i was taking daily ethambutol, rifampin and azithromyacin. Azithromycin zithromax rifampin rifadin rifabutin mycobutin ethambutol myambutol. Recently inhaled aerosolized amikacin has been used as a companion drug for patients with mac, especially for patients who have failed the standard treatment. Amikacin is a semisynthetic aminoglycoside antibiotic used in the treatment of gramnegative infections resistant to gentamicin.
Follow the patient without antibiotic therapy to evaluate the symptomatic and objective impact of mac lung. It is also used for the treatment of multidrugresistant tuberculosis. Jun 01, 2004 streptomycin, kanamycin, and amikacin can be administered either daily or 3 times weekly without affecting the likelihood of toxicity. Mycobacterium avium complex mac causes disseminated disease in up to 40% of patients with advanced human immunodeficiency virus hiv disease in the united states. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. About mac the university of texas health science center. Thrice weekly intravenous amk administration in outpatient settings is. Because many of these drugs have side effects, you should be monitored carefully while you are taking them. Treatment for nontuberculous mycobacterial lung disease.
Labcorp test details for mycobacterium avium complex susceptibility. Safety and effectiveness of lowdose amikacin in nontuberculous. However it is the least preferred because of possible cross resistance and the increased risk of adverse events compared with other injectables. Liposomeencapsulatedamikacin therapy of mycobacterium. What every practitioner needs to know are you sure your patient has disease due to slowly growing nontuberculous mycobacteria. For patients with mac lung disease or severe nodularbronchiectatic disease, a daily regime of clarithromycin or azithromycin, rifampin or rifabutin, and ethambutol with consideration of three times weekly amikacin or streptomycin early in therapy is recommended. A daily regimen of 500 mg aerosolized amikacin was then added. Can be dosed multiple times per day, once daily or a few times per week iv for nontuberculosis mycobacteria infections, higher doses at extended intervals are sometimes used e. The world health organization who guidelines state that all patients suspected of mdrtb should be given a group 2 injectable agent, usually an aminoglycoside.
Amikacin treatment for multidrug resistant tuberculosis. Pdf liposomeencapsulatedamikacin therapy of mycobacterium. Treatment of mycobacterium avium complex pulmonary disease. While on the amikacin, i had to have blood tests each week to have the level of the drug checked. Oct 17, 2019 mycobacterium avium complex mac consists of two species.
Amikacin was patented in 1971 and came into commercial use in 1976. Therefore, intermittent treatment could be considered in patients with recurrent noncavitary nodular bronchiectatic macpd when the isolate remains susceptible to macrolides. What every practitioner needs to know are you sure your patient has disease due to rapidly growing nontuberculous mycobacteria. Much more active against nontuberculous mycobacteria, especially mac, but some. Aug 22, 2011 of the three injectables recommended for drug resistant tb, amikacin is the most widely available. It is on the world health organizations list of essential medicines, the most effective and safe medicines needed in a health system. Nontuberculous mycobacterial infections in solid organ. The efficacy, safety, and feasibility of inhaled amikacin. Therapeutic drug monitoring in the treatment of mycobacterium. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs. You should be having an amikacin trough weekly to measure the therapuetic level. A recent cohort study showed that a threetimesweekly intermittent therapy.
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