Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | BMC Pharmacology and Toxicology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40360-019-0302-1 |
| _version_ | 1819073346555346944 |
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| author | Maria Luisa Aznar Theodore K. Marras Ahmed Said Elshal Mahtab Mehrabi Sarah K. Brode |
| author_facet | Maria Luisa Aznar Theodore K. Marras Ahmed Said Elshal Mahtab Mehrabi Sarah K. Brode |
| author_sort | Maria Luisa Aznar |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-21T17:52:10Z |
| format | Article |
| id | doaj.art-a4e45201c8134e809fc4ddd9332bdcf7 |
| institution | Directory Open Access Journal |
| issn | 2050-6511 |
| language | English |
| last_indexed | 2024-12-21T17:52:10Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pharmacology and Toxicology |
| spelling | doaj.art-a4e45201c8134e809fc4ddd9332bdcf72022-12-21T18:55:19ZengBMCBMC Pharmacology and Toxicology2050-65112019-06-012011910.1186/s40360-019-0302-1Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, CanadaMaria Luisa Aznar0Theodore K. Marras1Ahmed Said Elshal2Mahtab Mehrabi3Sarah K. Brode4Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health SystemJoint Division of Respirology, Department of Medicine, University Health Network and Sinai Health SystemJoint Division of Respirology, Department of Medicine, University Health Network and Sinai Health SystemJoint Division of Respirology, Department of Medicine, University Health Network and Sinai Health SystemJoint Division of Respirology, Department of Medicine, University Health Network and Sinai Health SystemAbstract 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.http://link.springer.com/article/10.1186/s40360-019-0302-1AmikacinNTM lung diseaseNontuberculous mycobacteria |
| spellingShingle | Maria Luisa Aznar Theodore K. Marras Ahmed Said Elshal Mahtab Mehrabi Sarah K. Brode Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada BMC Pharmacology and Toxicology Amikacin NTM lung disease Nontuberculous mycobacteria |
| title | Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada |
| title_full | Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada |
| title_fullStr | Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada |
| title_full_unstemmed | Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada |
| title_short | Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada |
| title_sort | safety and effectiveness of low dose amikacin in nontuberculous mycobacterial pulmonary disease treated in toronto canada |
| topic | Amikacin NTM lung disease Nontuberculous mycobacteria |
| url | http://link.springer.com/article/10.1186/s40360-019-0302-1 |
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