Once-daily dosing of amikacin for treatment of Mycobacterium abscessus lung disease

SETTING: Tertiary referral centre, Samsung Medical Center, South Korea. OBJECTIVE : To evaluate the pharmacokinetic parameters and toxicities of once-daily amikacin (AMK) dosing for lung disease due to Mycobacterium abscessus. DESIGN: A retrospective review of 48 patients with M. abscessus lung disease who received once-daily AMK for 4 weeks between January 2012 and June 2015. RESULTS : With a starting dose of 15 mg/kg/day and adjustment of AMK dose according to the peak serum level (C_max), the C_max, target of 55-65 μg/ml was achieved in 31.3% (15/48) of patients in the first week, 68.8% (33/48) in week 2, 91.7% (44/48) in week 3 and 95.8% (46/48) in week 4. Transient nephrotoxicity developed in 6.3% (3/48) of patients and ototoxicity in 25.0% (6/24), which was determined by audiogram as hearing loss, asymptomatic in five patients and tinnitus in one. Multivariate analysis revealed that the highest drug concentration 12 h after administration was significantly associated with the development of toxicities (adjusted odds ratio 1.862, P = 0.047). CONC LUS ION: Our results suggest that once-daily AMK for 4 weeks with a target _max of 55-65 μg/ml can be used in patients with M. abscessus lung disease, with careful monitoring of toxicity.