Average dosage is 250 mg 2 to 4 times weekly for 6 months. For patients with fibrocavitary mac lung disease or severe nodularbronchiectactic disease. The efficacy, safety, and feasibility of inhaled amikacin. Recommendations on prophylaxis and therapy for disseminated mycobacterium avium complex for adults and adolescents infected with human immunodeficiency virus.
In addition i was taking daily ethambutol, rifampin and azithromyacin. Patients with macrolidesusceptible mac were treated with azithromycin, 500 mg given three times weekly tiw. What every practitioner needs to know are you sure your patient has disease due to slowly growing nontuberculous mycobacteria. Thrice weekly intravenous amk administration in outpatient settings is. Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. Safety and effectiveness of lowdose amikacin in nontuberculous. Streptomycin, kanamycin, and amikacin can be administered either daily or 3 times weekly without affecting the likelihood of toxicity. Amikacin treatment for multidrug resistant tuberculosis. 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. 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. Amikacin is a semisynthetic aminoglycoside antibiotic used in the treatment of gramnegative infections resistant to gentamicin. 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. Doses were adjusted to achieve target serum concentrations.
There is no published study of the side effects or effectiveness of amikacin when given in this manner. The patient had never been on amikacin but had been on the latter two drugs at the same doses for the. Treatment for nontuberculous mycobacterial lung disease. However it is the least preferred because of possible cross resistance and the increased risk of adverse events compared with other injectables. Detailed amikacin dosage information for adults, the elderly and children. She might add amikacin or streptomycin three times a week early in your treatment. 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. 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 recent cohort study showed that a threetimesweekly intermittent therapy. 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.
Mycobacterium avium complex mac mycobacterium avium. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. To use nomogram for amikacin, divide the actual serum level of amikacin in half. Mac is the atypical mycobacterium most commonly associated with human disease. 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. The tiw regimen consists of azithromycin 500 to 600 mg or. Labcorp test details for mycobacterium avium complex susceptibility. Amikacin works most effectively the higher the concentration of the drug exceeds the mic of the target organism. Liposomeencapsulatedamikacin therapy of mycobacterium. Jun 01, 2004 streptomycin, kanamycin, and amikacin can be administered either daily or 3 times weekly without affecting the likelihood of toxicity. Out of 96 patients who received amikacin for more than 3 months. Past studies have shown the potential for sporadic development of amikacin resistance in mac among patients on inhaled amikacin.
The patient was started on three times weekly 300 mg rifabutin and 35 mg ethambutolkg of body weight see fig. 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. Because many of these drugs have side effects, you should be monitored carefully while you are taking them. Dec 02, 2019 10 to 15 mgkg iv once or 25 mgkg iv 3 times a week use. Current opinions in the treatment of pulmonary nontuberculous. Pdf liposomeencapsulatedamikacin therapy of mycobacterium. This includes joint infections, intraabdominal infections, meningitis, pneumonia, sepsis, and urinary tract infections. About mac the university of texas health science center. Clinical efficacy and safety of multidrug therapy including thrice. Mycobacterium avium complex mac causes disseminated disease in up to 40% of patients with advanced human immunodeficiency virus hiv disease in the united states. Ivs 3 times a week for non aids mac mai lung disease.
Third or fourth drug option as an alternative treatment in patients with disseminated mycobacterium avium complex mac. 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. Multidrugresistant tuberculosis mdrtb is an increasing global problem. Treatment of mycobacterium avium complex pulmonary disease. 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. 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. Should consider three times weekly amikacin or streptomycin iv early in therapy. The general dosing range for daily iv amikacin is 7 to 14mg. You should be having an amikacin trough weekly to measure the therapuetic level. In addition to the mac, i also had massiliense which is another ntm and not very successful to 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. 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.
Amikacin epikacin uses, side effects, dose and brands. When a three times weekly dosing schedule was available, the. 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. Amikacin works by blocking the function of the bacterias 30s ribosomal subunit, making it unable to produce proteins. Because intermittent therapy was not popular in korea during this study period, many patients with nodular bronchiectatic disease were still receiving daily antibiotic therapy. In multidrug regimens, including an intravenous aminoglycoside e.
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. Therapeutic drug monitoring in the treatment of mycobacterium. High variability in amikacin concentrations were observed cv% 100%. Of the three injectables recommended for drug resistant tb, amikacin is the most widely available. Mac macrolide azithromycin 12 mo 56% to 85% ethambutol rifamycin m. Has only been studied for refractory mac lung disease. It is on the world health organizations list of essential medicines, the most effective and safe medicines needed in a health system. Pharmacotherapy approaches in nontuberculous mycobacteria. Nontuberculous mycobacterial infections in solid organ. Streptomycin was administered intramuscularly in some patients with severe. Clarithromycin biaxin clarithromycin belongs to a class of drugs known as macrolides. Amikacin therapeutic drug monitoring interpretive notes antibiotic assays version 2, february 2009.
Unfortunately, i was being treated for 2 ntm pathogens mac and massiliense. 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. Patients with renal dysfunction andor those who are older may require 15 mgkg given 3 times a week. A daily regimen of 500 mg aerosolized amikacin was then added. For the full time i was on the amikacin i had a hearing test weekly. 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.
Amikacin inhalation as salvage therapy for refractory. Azithromycin zithromax rifampin rifadin rifabutin mycobutin ethambutol myambutol. Amikacin liposome is considered experimental, investigational or unproven for any other use including. Myambutol ethambutol hydrochloride dose, indications. Therefore achieving a peak between 2030mgl will be. Oct 16, 2014 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. Among the five patients with coinfection of mac, three showed. The study population consisted of patients with ntm. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs. Aminoglycoside dosing and monitoring recommendations.
Aug 22, 2011 of the three injectables recommended for drug resistant tb, amikacin is the most widely available. 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. Amikacin sulfate amikacin sulfate dose, indications. The efficacy, safety, and feasibility of inhaled amikacin for. While on the amikacin, i had to have blood tests each week to have the level of the drug checked. Amikacin is an antibiotic used for a number of bacterial infections.
Oct 17, 2019 mycobacterium avium complex mac consists of two species. Aminoglycoside dosing guidelines for adults necessary patient information for dosing ideal body weight ibw. 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. Can be dosed multiple times per day, once daily or a few times per week iv. Much more active against nontuberculous mycobacteria, especially mac, but some. I took it 5x per week for three months, then 3x per week for three months. Amikacin was patented in 1971 and came into commercial use in 1976.
I would not be concerned about the numbers if you are having weekly amikacin trough levels drawn. Liposomeencapsulatedamikacin therapy of mycobacterium avium complex infection in beige mice. Drugresistant tuberculosis curry international tuberculosis center. 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. 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. Treatment of mac for most patients with nodularbronchiectatic disease includes a three times weekly regiment of clarithromycin or azithromycin, rifampin, and ethambutol. The pathogen mycobacterium avium complex mac is the most common cause of. Follow the patient without antibiotic therapy to evaluate the symptomatic and objective impact of mac lung. Therefore, intermittent treatment could be considered in patients with recurrent noncavitary nodular bronchiectatic macpd when the isolate remains susceptible to macrolides. Clinical efficacy and safety of multidrug therapy including. It is a very powerful drug with many bad side effects. 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 target csf levels of amikacin should be 10 to 20 times that of the mic of the organism. New therapies, including clofazimine, inhaled amikacin, and. It is used either by injection into a vein or muscle amikacin, like other aminoglycoside antibiotics, can cause hearing loss, balance. Mycobacterium avium complex mac consists of two species. Slowly growing nontuberculous mycobacterial infections. 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. Th e macrolide was omitted if the mac isolate was macrolide resistant. Daily regimen of clarithromycin 500mg or azithromycin 250mg, rifampin 600mg or rifabutin 150300mg and ethambutol 15mgkg. What every practitioner needs to know are you sure your patient has disease due to rapidly growing nontuberculous mycobacteria. I also had to have a weekly hearing test which took hours each week. Recently inhaled aerosolized amikacin has been used as a companion drug for patients with mac, especially for patients who have failed the standard treatment. The world health organization who guidelines state that all patients suspected of mdrtb should be given a group 2 injectable agent, usually an aminoglycoside. Nontuberculous mycobacteria ntm can infect almost any organ in the body, thus, signs and symptoms will vary depending on the site of infection. Preliminary results of bedaquiline as salvage therapy for.
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