The role of amikacin in the treatment of nontuberculous mycobacterial disease

Abstract

<b>Introduction</b>: Guidelines recommend the use of amikacin in the treatment of nontuberculous mycobacterial (NTM) disease. The authors have evaluated the evidence for the position of amikacin in NTM disease treatment.<b>Areas covered</b>: The authors performed a literature search for original research on amikacin in NTM disease, including its mechanism of action, emergence of resistance, pre-clinical and clinical investigations.<b>Expert opinion</b>: Amikacin shows moderate <i>in vitro</i> activity against the clinically most relevant NTM species (<i>M. avium</i> complex and <i>M. abscessus</i>). It is synergistic with ethambutol, clofazimine, and macrolides and these combinations are effective in animal models. Liposomal encapsulation increases amikacin efficacy. Clinically, the recommended dose of 15 mg/kg intravenous amikacin does not lead to PK/PD target attainment in all patients and a positive impact on long-term treatment outcomes remains unproven in both <i>M. avium</i> complex and <i>M. abscessus</i> disease. Adding the amikacin liposome inhalation suspension did prove to be effective in short and long term in patients not responding to recommended treatment for <i>M. avium</i> complex pulmonary disease. Its optimal use in <i>M. avium</i> complex and <i>M. abscessus</i> pulmonary disease warrants further evaluation.