1. Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto
- Author
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María Luisa Aznar, Ahmed Said Elshal, Mahtab Mehrabi, Sarah K. Brode, Theodore K. Marras, Institut Català de la Salut, [Aznar ML] Joint Division of Respirology, Department of Medicine, University Health Network Toronto, Canada. Sinai Health System, Toronto, Canada. Servei de Medicina, Hospital Universitari Vall d'Hebron, Barcelona, Spain. PROSICS Barcelona, Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain. [Marras TK, Mehrabi M] Joint Division of Respirology, Department of Medicine, University Health Network Toronto, Canada. Sinai Health System, Toronto, Canada. [Elshal AS] Joint Division of Respirology, Department of Medicine, University Health Network Toronto, Canada. Sinai Health System, Toronto, Canada. Gastroenterology Department, National Hepatology and Tropical Medicine Institute, Cairo, Egypt. [Brode SK] Joint Division of Respirology, Department of Medicine, University Health Network Toronto, Canada. Sinai Health System, Toronto, Canada. West Park Healthcare Centre, Toronto, Canada., and Vall d'Hebron Barcelona Hospital Campus
- Subjects
hidratos de carbono::glicósidos::aminoglicósidos::kanamicina::amicacina [COMPUESTOS QUÍMICOS Y DROGAS] ,Male ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,030226 pharmacology & pharmacy ,NTM lung disease ,0302 clinical medicine ,Pharmacology (medical) ,Carbohydrates::Glycosides::Aminoglycosides::Kanamycin::Amikacin [CHEMICALS AND DRUGS] ,Nontuberculous mycobacteria ,Otros calificadores::Otros calificadores::/tratamiento farmacológico [Otros calificadores] ,Ontario ,biology ,Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Actinomycetales Infections::Mycobacterium Infections::Mycobacterium Infections, Nontuberculous [DISEASES] ,Low dose ,Toronto ,Middle Aged ,Anti-Bacterial Agents ,Treatment Outcome ,Amikacin ,Cohort ,Other subheadings::Other subheadings::/administration & dosage [Other subheadings] ,Administration, Intravenous ,Female ,medicine.symptom ,Research Article ,medicine.drug ,Adult ,medicine.medical_specialty ,Mycobacterium Infections, Nontuberculous ,Pulmonary disease ,03 medical and health sciences ,Ototoxicity ,lcsh:RA1190-1270 ,Internal medicine ,Micobacteriosis - Quimioteràpia - Toronto ,medicine ,Humans ,lcsh:Toxicology. Poisons ,Aged ,Retrospective Studies ,Pharmacology ,Otros calificadores::Otros calificadores::/administración & dosificación [Otros calificadores] ,business.industry ,lcsh:RM1-950 ,Sputum ,bacterial infections and mycoses ,biology.organism_classification ,medicine.disease ,Aminoglucòsids ,Regimen ,lcsh:Therapeutics. Pharmacology ,Medicaments - Administració ,Bacteria::bacterias grampositivas::Actinobacteria::Actinomycetales::Mycobacteriaceae::Mycobacterium::micobacterias no tuberculosas [ORGANISMOS] ,business - Abstract
Amikacin; NTM lung disease; Nontuberculous mycobacteria Amikacina; Malaltia pulmonar per micobacteri no tuberculós; Micobacteri no tuberculós Amikacina; Enfermedad pulmonar por micobacteria no tuberculosa; Micobacteria no tuberculosa BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
- Published
- 2019