Clinical efficacy and safety of multidrug therapy including thrice weekly intravenous amikacin administration for Mycobacterium abscessus pulmonary disease in outpatient settings: a case series. Issue 1 (December 2016) - Namkoong, Ho
Abstract Background Mycobacterium abscessus (M. abscessus ) pulmonary disease is a refractory chronic infectious disease. Options for treatingM. abscessus pulmonary disease are limited, especially in outpatient settings. Among parenteral antibiotics againstM. 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 withM. abscessus pulmonary disease. Methods This retrospective chart review of cases ofM. 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. Results Thirteen patients (2 men and 11 women) withM. 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. Conclusions Thrice weekly intravenous AMK administration in outpatient settings is effective and safe for patients withM. abscessus pulmonary disease.