RATIONALE: Treatment of pulmonary nontuberculous mycobacteria, especially Mycobacterium abscessus, requires prolonged, multidrug regimens with high toxicity and suboptimal efficacy. Options for refractory disease are limited. OBJECTIVES: 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. MEASUREMENTS AND MAIN 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.
RATIONALE: Treatment of pulmonary nontuberculous mycobacteria, especially Mycobacterium abscessus, requires prolonged, multidrug regimens with high toxicity and suboptimal efficacy. Options for refractory disease are limited. OBJECTIVES: 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. MEASUREMENTS AND MAIN 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.
Authors: David E Griffith; Timothy Aksamit; Barbara A Brown-Elliott; Antonino Catanzaro; Charles Daley; Fred Gordin; Steven M Holland; Robert Horsburgh; Gwen Huitt; Michael F Iademarco; Michael Iseman; Kenneth Olivier; Stephen Ruoss; C Fordham von Reyn; Richard J Wallace; Kevin Winthrop Journal: Am J Respir Crit Care Med Date: 2007-02-15 Impact factor: 21.405
Authors: Kyeongman Jeon; O Jung Kwon; Nam Yong Lee; Bum-Joon Kim; Yoon-Hoh Kook; Seung-Heon Lee; Young Kil Park; Chang Ki Kim; Won-Jung Koh Journal: Am J Respir Crit Care Med Date: 2009-08-06 Impact factor: 21.405
Authors: Won-Jung Koh; Kyeongman Jeon; Nam Yong Lee; Bum-Joon Kim; Yoon-Hoh Kook; Seung-Heon Lee; Young Kil Park; Chang Ki Kim; Sung Jae Shin; Gwen A Huitt; Charles L Daley; O Jung Kwon Journal: Am J Respir Crit Care Med Date: 2010-09-10 Impact factor: 21.405
Authors: Adrian M Zelazny; Jeremy M Root; Yvonne R Shea; Rhonda E Colombo; Isdore C Shamputa; Frida Stock; Sean Conlan; Steven McNulty; Barbara A Brown-Elliott; Richard J Wallace; Kenneth N Olivier; Steven M Holland; Elizabeth P Sampaio Journal: J Clin Microbiol Date: 2009-05-06 Impact factor: 5.948
Authors: Charles A Peloquin; Shaun E Berning; Annette T Nitta; Patricia M Simone; Marian Goble; Gwen A Huitt; Michael D Iseman; James L Cook; Douglas Curran-Everett Journal: Clin Infect Dis Date: 2004-05-05 Impact factor: 9.079
Authors: Kenneth N Olivier; David E Griffith; Gina Eagle; John P McGinnis; Liza Micioni; Keith Liu; Charles L Daley; Kevin L Winthrop; Stephen Ruoss; Doreen J Addrizzo-Harris; Patrick A Flume; Daniel Dorgan; Matthias Salathe; Barbara A Brown-Elliott; Renu Gupta; Richard J Wallace Journal: Am J Respir Crit Care Med Date: 2017-03-15 Impact factor: 21.405
Authors: Julie V Philley; Mary Ann DeGroote; Jennifer R Honda; Michael M Chan; Shannon Kasperbauer; Nicholas D Walter; Edward D Chan Journal: Curr Treat Options Infect Dis Date: 2016-10-11