title: Clinical efficacy and safety of multidrug therapy including thrice weekly intravenous amikacin administration for Mycobacterium abscessus pulmonary disease in outpatient settings: a case series.
abstract: Mycobacterium abscessus (M. abscessus) pulmonary disease is a refractory chronic infectious disease. Options for treating M. abscessus pulmonary disease are limited, especially in outpatient settings. Among parenteral antibiotics against M. abscessus, intravenous amikacin (AMK) is expected to be an effective outpatient antimicrobial therapy. This study evaluated the clinical efficacy and safety of intravenous AMK therapy in outpatients with M. abscessus pulmonary disease.
  
  
  
  This retrospective chart review of cases of M. abscessus pulmonary disease evaluated patient background data, AMK dosage and duration, sputum conversion, clinical symptoms radiological findings, and adverse events. M. massiliense was excluded on the basis of multiplex PCR assay.
  
  
  
  Thirteen patients (2 men and 11 women) with M. abscessus pulmonary disease were enrolled at 2 hospitals. The median age at the initiation of intravenous AMK treatment was 65 years (range: 50-86 years). Patients received a median AMK dose of 12.5 mg/kg (range: 8.3-16.2 mg/kg) for a median duration of 4 months (range: 3-9 months). The addition of intravenous AMK led to sputum conversion in 10 of 13 patients, and 8 patients continued to have negative sputum status 1 year after treatment. Approximately half of the patients showed improvement on chest high-resolution computed tomography. There were no severe adverse events such as ototoxicity, vestibular toxicity, and renal toxicity.
  
  
  
  Thrice weekly intravenous AMK administration in outpatient settings is effective and safe for patients with M. abscessus pulmonary disease.
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.|Japan Society for the Promotion of Science, Tokyo, Japan.|Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan.
authors: Ho
authors: H
authors: Namkoong
authors: Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors: Kozo
authors: K
authors: Morimoto
authors: Keio University Health Center, Tokyo, Japan.
authors: Tomoyasu
authors: T
authors: Nishimura
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Hiromu
authors: H
authors: Tanaka
authors: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors: Hiroaki
authors: H
authors: Sugiura
authors: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors: Yoshitake
authors: Y
authors: Yamada
authors: Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors: Atsuko
authors: A
authors: Kurosaki
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Takanori
authors: T
authors: Asakura
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Shoji
authors: S
authors: Suzuki
authors: Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors: Hiroshi
authors: H
authors: Fujiwara
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Kazuma
authors: K
authors: Yagi
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Makoto
authors: M
authors: Ishii
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Sadatomo
authors: S
authors: Tasaka
authors: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Tomoko
authors: T
authors: Betsuyaku
authors: Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Yoshihiko
authors: Y
authors: Hoshino
authors: Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors: Atsuyuki
authors: A
authors: Kurashima
authors: Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. n-hasegawa@z8.keio.jp.
authors: Naoki
authors: N
authors: Hasegawa
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000235:genetics / Q000472:pathogenicity; D010045:Outpatients; D012189:Retrospective Studies; D013183:Sputum / Q000187:drug effects / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin
keywords: Amikacin; Intravenous therapy; Mycobacterium abscessus; Outpatient treatment; Rapid-growing mycobacterium