<p>The Use of Amikacin Liposome Inhalation Suspension (Arikayce) in the Treatment of Refractory Nontuberculous Mycobacterial Lung Disease in Adults</p>

Abstract

Nontuberculous mycobacteria (NTM) can cause and perpetuate chronic inflammation and lung infection. Despite having the diagnostic criteria, as defined by the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA), clinicians find it challenging to diagnose and treat NTM-induced lung disease. Inhaled antibiotics are suitable for patients with lung infection caused by Pseudomonas aeruginosa and other organisms, but until recently, their utility in NTM-induced infection was not established. The most common NTM pathogens identified are the slow-growing Mycobacterium avium complex (MAC) and the rapid-growing M. abscessus complex (MABSC), both of which include several subspecies. Other less commonly isolated species include M. kansasii, M. simiae, and M. fortuitum. NTM strains are frequently more resistant than what is found in bacterial sputum cultures. Until recently, there was no approved inhaled antibiotic therapy for patients who were culture positive for pulmonary NTM infection. Of late, inhaled amikacin has been under investigation for the treatment of NTM-induced pulmonary infection. The FDA approved Arikayce (amikacin liposome inhalation suspension or ALIS) based on results from the ongoing Phase 3 CONVERT trial. In this study, the use of Arikayce met its primary endpoint of sputum culture conversion by the sixth month of treatment. The addition of Arikayce to guidelinebased therapy led to negative sputum cultures for NTM by month 6 in 29% of patients compared to 8.9% of patients treated with guideline-based therapy alone. The effectiveness of Arikayce holds promise. However, due to limited data on Arikayce's safety, it is currently useful only for a specific population, particularly patients with refractory NTM-induced lung disease. Future trials must verify the target group and endorse the clinical benefits of Arikayce.

Initial In Vivo Evaluation of a Novel Amikacin-Deoxycholate Hydrophobic Salt Delivers New Insights on Amikacin Partition in Blood and Tissues

“…If such binding is confirmed in humans, based on previous long-dated literature warning for potential aminoglycoside accumulation in humans [ 42 , 43 , 46 ], and considering the current once-a-day inhaled Amk treatments [ 28 ], rethinking the current regimen may be recommended to prevent important side effects over prolonged exposure. Further studies are planned to untwine this noteworthy as well as critical aspect.…”

“…A single-dose PK study was performed in healthy mice after i.n. instillation of free Amk and Amk-DCA at 8 mg/kg dose [ 28 ]. Sixty-three mice were randomly divided into 3 groups: (1) a control group treated with physiological solution ( n = 3), (2) a group treated with Amk solution ( n = 30), (3) a group treated with Amk-DCA suspension ( n = 30).…”

Nanobiosystems for Antimicrobial Drug-Resistant Infections

“…Due to their hydrophobicity, MOTT species are abundant in different environments such as water, soil, foods, etc., can survive at high temperatures and in low pH media, and can be aerosolized and form biofilms. The molecular mechanisms of MOTT-induced infections are similar to that of tuberculosis [ 212 , 213 ]. Inhalation of MOTT-contaminated aerosolized droplets is the mode of transmission of pulmonary infections [ 213 ].…”

“…The molecular mechanisms of MOTT-induced infections are similar to that of tuberculosis [ 212 , 213 ]. Inhalation of MOTT-contaminated aerosolized droplets is the mode of transmission of pulmonary infections [ 213 ].…”

“…Although MOTT-induced infections are generally not contagious, recent evidence suggests transfer among cystic fibrosis patients. MOTT lung disease prevalence has been increasing in the last few years [ 213 ]. Treatment of MOTT lung disease is challenging; regimens containing a macrolide, ethambutol, and a rifamycin (rifampin or rifabutin) are usually considered.…”