BACKGROUND Treatment guidelines suggest either a low-dose or high-dose approach when prescribing amikacin for nontuberculous mycobacterial pulmonary disease (NTM PD), but data supporting the low-dose approach are limited. The purpose of this study was to describe the safety and efficacy of the use of a low-dose of intravenous amikacin in a cohort of patients with NTM PD. METHODS We retrospectively reviewed all patients with NTM PD who received amikacin at our institution between July 1, 2003 and February 28, 2017. Demographics, clinical, microbiological and radiological data, indication and dose of amikacin, and adverse drug effects were recorded. RESULTS A total of 107 patients received a regimen containing amikacin for a median (IQR) of 7 (4-11) months. Seventy (65.4%) were female and the mean age (SD) was 58.3 (14.9) years. Amikacin was started at a median dose of 9.9 (2.5) mg/kg/day. Ototoxicity was observed in 30/77 (39%) patients and it was related to female sex (OR 4.96, 95%CI 1.24-19.87), and total dose of amikacin per bodyweight (OR 1.62, 95%CI 1.08-2.43). Patients of East Asian ethnicity were less likely to develop ototoxicity (0.24, 95%CI 0.06-0.95). Out of 96 patients who received amikacin for more than 3 months, 65 (67.7%) experienced symptom improvement and 30/62 (49.2%) converted their sputum to culture negative within a year. CONCLUSIONS Patients with NTM PD treated with low-dose intravenous amikacin frequently developed ototoxicity, which was associated with female sex, and total dose of amikacin per bodyweight. Physicians should carefully consider dose, treatment duration, and long term prognosis in balancing risks and benefits of intravenous amikacin in NTM PD.

中文翻译：

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小剂量阿米卡星在加拿大多伦多治疗的非结核分枝杆菌性肺疾病中的安全性和有效性。

背景技术治疗指南建议在为非结核性分枝杆菌性肺病（NTM PD）开具阿米卡星处方时使用低剂量或高剂量方法，但支持低剂量方法的数据有限。这项研究的目的是描述在NTM PD患者队列中使用小剂量静脉注射阿米卡星的安全性和有效性。方法我们回顾性回顾了2003年7月1日至2017年2月28日在我院接受阿米卡星治疗的所有NTM PD患者。记录了人口统计学，临床，微生物学和放射学数据，阿米卡星的适应症和剂量以及药物不良反应。结果共有107例患者接受了含丁胺卡那霉素的方案，中位（IQR）为7（4-11）个月。七十（65.4％）为女性，平均年龄（SD）为58.3（14.9）岁。阿米卡星的起始中位剂量为9.9（2.5）mg / kg /天。在30/77（39％）患者中观察到耳毒性，它与女性（OR 4.96，95％CI 1.24-19.87）和每体重阿米卡星的总剂量有关（OR 1.62，95％CI 1.08-2.43）。东亚族裔患者发生耳毒性的可能性较小（0.24，95％CI 0.06-0.95）。在接受阿米卡星治疗3个月以上的96例患者中，有65例（67.7％）症状得到改善，一年中30/62例（49.2％）的痰液转变为培养阴性。结论低剂量静脉注射阿米卡星治疗的NTM PD患者经常发生耳毒性，这与女性性别和每体重的阿米卡星总剂量有关。医生应仔细考虑剂量，治疗时间，