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Free Content Once-daily dosing of amikacin for treatment of Mycobacterium abscessus lung disease

SETTING: Tertiary referral centre, Samsung Medical Center, South Korea.

OBJECTIVE: To evaluate the pharmacokinetic parameters and toxicities of once-daily amikacin (AMK) dosing for lung disease due to Mycobacterium abscessus.

DESIGN: A retrospective review of 48 patients with M. abscessus lung disease who received once-daily AMK for 4 weeks between January 2012 and June 2015.

RESULTS: With a starting dose of 15 mg/kg/day and adjustment of AMK dose according to the peak serum level (Cmax), the Cmax target of 55–65 μg/ml was achieved in 31.3% (15/48) of patients in the first week, 68.8% (33/48) in week 2, 91.7% (44/48) in week 3 and 95.8% (46/48) in week 4. Transient nephrotoxicity developed in 6.3% (3/48) of patients and ototoxicity in 25.0% (6/24), which was determined by audiogram as hearing loss, asymptomatic in five patients and tinnitus in one. Multivariate analysis revealed that the highest drug concentration 12 h after administration was significantly associated with the development of toxicities (adjusted odds ratio 1.862, P = 0.047).

CONCLUSION: Our results suggest that once-daily AMK for 4 weeks with a target Cmax of 55–65 μg/ml can be used in patients with M. abscessus lung disease, with careful monitoring of toxicity.

Keywords: AMK; M. abscessus; nephrotoxicity; non-tuberculous mycobacteria; ototoxicity

Document Type: Research Article

Affiliations: 1: Division of Pulmonary and Critical Care Medicine, Department of Medicine 2: Department of Pharmaceutical Services 3: Department of Laboratory Medicine and Genetics 4: Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 5: Department of Microbiology, Yonsei University College of Medicine, Seoul, South Korea

Publication date: July 1, 2017

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