Inhaled amikacin for treatment of refractory pulmonary nontuberculous mycobacterial disease.
BACKGROUND
Treatment of pulmonary nontuberculous mycobacteria, especially Mycobacterium abscessus, requires prolonged, multidrug regimens with high toxicity and suboptimal efficacy. Options for refractory disease are limited.


OBJECTIVE
We reviewed the efficacy and toxicity of inhaled amikacin in patients with treatment-refractory nontuberculous mycobacterial lung disease.


METHODS
Records were queried to identify patients who had inhaled amikacin added to failing regimens. Lower airway microbiology, symptoms, and computed tomography scan changes were assessed together with reported toxicity.


RESULTS
The majority (80%) of the 20 patients who met entry criteria were women; all had bronchiectasis, two had cystic fibrosis and one had primary ciliary dyskinesia. At initiation of inhaled amikacin, 15 were culture positive for M. abscessus and 5 for Mycobacterium avium complex and had received a median (range) of 60 (6, 190) months of mycobacterial treatment. Patients were followed for a median of 19 (1, 50) months. Eight (40%) patients had at least one negative culture and 5 (25%) had persistently negative cultures. A decrease in smear quantity was noted in 9 of 20 (45%) and in mycobacterial culture growth for 10 of 19 (53%). Symptom scores improved in nine (45%), were unchanged in seven (35%), and worsened in four (20%). Improvement on computed tomography scans was noted in 6 (30%), unchanged in 3 (15%), and worsened in 11 (55%). Seven (35%) stopped amikacin due to: ototoxicity in two (10%), hemoptysis in two (10%), and nephrotoxicity, persistent dysphonia, and vertigo in one each.


CONCLUSIONS
In some patients with treatment-refractory pulmonary nontuberculous mycobacterial disease, the addition of inhaled amikacin was associated with microbiologic and/or symptomatic improvement; however, toxicity was common. Prospective evaluation of inhaled amikacin for mycobacterial disease is warranted.
1 Laboratory of Clinical Infectious Diseases.
Kenneth N
KN
Olivier
Pamela A
PA
Shaw
Tanya S
TS
Glaser
Darshana
D
Bhattacharyya
Michelle
M
Fleshner
Carmen C
CC
Brewer
Christopher K
CK
Zalewski
Les R
LR
Folio
Jenifer R
JR
Siegelman
Shamira
S
Shallom
In Kwon
IK
Park
Elizabeth P
EP
Sampaio
Adrian M
AM
Zelazny
Steven M
SM
Holland
D Rebecca
DR
Prevots
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001987:Bronchiectasis / Q000150:complications; D003550:Cystic Fibrosis / Q000150:complications; D005260:Female; D006801:Humans; D007619:Kartagener Syndrome / Q000150:complications; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000188:drug therapy*; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000188:drug therapy; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D000583:Amikacin