From the Guidelines
Amikacin for nodular non-tuberculous mycobacterial (NTM) infections is typically administered three times per week, with a standard dosage of 15–25 mg/kg per dose, adjusted according to drug level monitoring, as part of a multi-drug treatment regimen. This regimen is based on the most recent and highest quality study, which recommends a three-times-weekly dosing schedule to balance the drug's effectiveness against its potential for toxicity, particularly ototoxicity and nephrotoxicity 1. The treatment duration with amikacin is generally limited to 2-3 months within a longer overall treatment course of 12-18 months for nodular NTM.
Some key points to consider when administering amikacin for NTM infections include:
- Dosing frequency may be adjusted based on the patient's renal function and therapeutic drug monitoring 1
- It's crucial to monitor serum drug levels, auditory function, and renal function regularly during treatment 1
- The intermittent dosing schedule allows for adequate drug exposure while minimizing the risk of adverse effects associated with daily administration 1
- Amikacin may be given in combination with other drugs, such as macrolides, ethambutol, and rifampin, as part of a multi-drug treatment regimen 1
Overall, the goal of treatment is to achieve a balance between effectively treating the infection and minimizing the risk of adverse effects, with a focus on improving morbidity, mortality, and quality of life outcomes for patients with NTM infections.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: The recommended dosage for adults, children and older infants with normal renal function is 15 mg/kg/day divided into 2 or 3 equal doses administered at equally-divided intervals, i.e., 7.5 mg/kg q12h or 5 mg/kg q8h.
The frequency of administering amikacin for nodular non-tuberculous mycobacteria (NTM) infections is every 8 or 12 hours, with a recommended dosage of 7.5 mg/kg q12h or 5 mg/kg q8h for patients with normal renal function 2.
From the Research
Frequency of Administering Amikacin for Nodular Non-Tuberculous Mycobacteria (NTM) Infections
- The frequency of administering amikacin for nodular NTM infections is not explicitly stated in the provided studies as a standard protocol.
- However, according to 3, for patients with cavitation, with pronounced nodular bronchiectatic disease or with macrolide resistance, daily oral therapy should be expanded by parenteral amikacin or streptomycin.
- Additionally, 3 recommends that patients with nodular-bronchiectatic disease manifestation should receive oral macrolide-based therapy, which - depending on the extent - can be given 3 times a week.
- In the case of refractory or recurrent NTM lung disease, liposomally encapsulated amikacin for inhalation is recommended 3, 4.
- The study 5 compared the treatment outcomes of cavitary Mycobacterium avium complex pulmonary disease with streptomycin or amikacin use, but it does not provide information on the frequency of amikacin administration for nodular NTM infections.
- The review 6 discusses the current recommendations for the treatment of NTM infections, including the use of amikacin, but does not specify the frequency of administration for nodular NTM infections.