Amikacin causes little toxicity in carefully selected and closely monitored patients with non-tuberculous mycobacterial (NTM) disease but is less effective than previously thought, according to a case series published by Brisbane respiratory physicians.
Dr Claire Ellender, from the Princess Alexandra Hospital, and colleagues described 45 patients treated at three Brisbane hospitals between 2002 and 2012.
There were 25 with Mycobacterium intracellulare, 13 with Mycobacterium abscessus, six with Mycobacterium avium and one with Mycobacterium fortuitum.
They had been heavily pre-treated before receiving amikacin, and most had comorbidities including bronchiectasis and COPD.
The usual course of amikacin was 22 mg/kg/day given three times weekly for 8 weeks. It was used as part of multi-drug regimens that included antibiotics such as ethambutol, clarithromycin, rifampicin, azithromycin and clofazimine.
Eight patients experienced transient ototoxicity but only three had long-term hearing loss. There were no cases of nephrotoxicity and no long-term vestibulotoxicity.