title: Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series.
abstract: BACKGROUND
  Current systemic therapy for nontuberculous mycobacterial pulmonary infection is limited by poor clinical response rates, drug toxicities and side effects. The addition of aerosolized amikacin to standard oral therapy for nontuberculous mycobacterial pulmonary infection may improve treatment efficacy without producing systemic toxicity. This study was undertaken to assess the safety, tolerability and preliminary clinical benefits of the addition of aerosolized amikacin to a standard macrolide-based oral treatment regimen.
  
  
  METHODS
  Six HIV-negative patients with Mycobacterium avium intracellulare pulmonary infections who had failed standard therapy were administered aerosolized amikacin at 15 mg/kg daily in addition to standard multi-drug macrolide-based oral therapy. Patients were monitored clinically and serial sputum cultures were obtained to assess response to therapy. Symptomatic improvement with radiographic stabilization and eradication of mycobacterium from sputum were considered markers of success. Of the six patients treated with daily aerosolized amikacin, five responded to therapy. All of the responders achieved symptomatic improvement and four were sputum culture negative after 6 months of therapy. Two patients became re-infected with Mycobacterium avium intracellulare after 7 and 21 months of treatment. One of the responders who was initially diagnosed with Mycobacterium avium intracellulare became sputum culture positive for Mycobacterium chelonae resistant to amikacin after being on intermittent therapy for 4 years. One patient had progressive respiratory failure and died despite additional therapy. There was no evidence of nephrotoxicity or ototoxicity associated with therapy.
  
  
  CONCLUSIONS
  Aerosolized delivery of amikacin is a promising adjunct to standard therapy for pulmonary nontuberculous mycobacterial infections. Larger prospective trials are needed to define its optimal role in therapy of this disease.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA, USA. kkdavis74@hotmail.com
authors.forename: Kala K
authors.initials: KK
authors.lastname: Davis
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kao
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jacobs
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ruoss
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy*; D018942:Macrolides / Q000008:administration & dosage; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D000583:Amikacin