Inhaled Amikacin – pro
The incidence of chronic pulmonary disease caused by nontuberculous mycobacteria (NTM) in human immunodeficiency virus (HIV)-negative patients has been increasing worldwide. Treating NTM lung diseases can be extremely difficult and may require multiple drugs.
Amikacin is an effective antibiotic for NTM infection. However, intravenous amikacin treatment is limited by its systemic route of administration and a lot of adverse events. Amikacin inhalation treatment could overcome these limitations and also could be effective for treatment of NTM pulmonary disease due to maintaining a high lung concentration. For this reason, there is an interest in delivering Amikacin directly to the lung by inhalation. Potential benefits include target drug delivery directly to the site of action, achieving high, microbiologically relevant
concentrations in respiratory secretions in excess of the
in vitro MIC of the infective organism(s reducing the risks of adverse effects associated
with parenteral administration by limiting systemic
exposure and limiting the emergence and spread of antimicrobial resistance. This approach is under active study for pseudomonas infections and in cystic fibrosis, for example, nhaled Amikacin Solution BAY41-6551 as Adjunctive Therapy in the Treatment of Gram-Negative Pneumonia (INHALE 1), NCT01799993. Many questions remain and the kinetics, penetration and tissue concentrations still need to be worked out.
David E. Griffith, Timothy Aksamit, Barbara A. Brown-Elliott, Antonino Catanzaro, Charles Daley, Fred Gordin, Steven M. Holland, Robert Horsburgh, Gwen Huitt, Michael F. Iademarco, Michael Iseman, Kenneth Olivier, Stephen Ruoss, C. Fordham von Reyn, Richard J. Wallace, Jr., and Kevin Winthrop “An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases”, American Journal of Respiratory and Critical Care Medicine, Vol. 175, No. 4 (2007), pp. 367-416.
Charles-Edouard Luyte, Pharmacokinetics and lung delivery of PDDS-aerosolized amikacin (NKTR-061) in intubated and mechanically ventilated patients with nosocomial pneumonia. Crit Care. 2009; 13(6): R200.
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