Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Radboudumc Center for Infectious Diseases, Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Expert Opin Pharmacother. 2021 Oct;22(15):1961-1974. doi: 10.1080/14656566.2021.1953472. Epub 2021 Jul 22.
: 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.: 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.: Amikacin shows moderate activity against the clinically most relevant NTM species ( complex and ). 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 complex and 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 complex pulmonary disease. Its optimal use in complex and pulmonary disease warrants further evaluation.
: 指南建议使用阿米卡星治疗非结核分枝杆菌（NTM）病。作者评估了阿米卡星在 NTM 病治疗中的地位的证据。: 作者对 NTM 病中阿米卡星的原始研究进行了文献检索，包括其作用机制、耐药性的出现、临床前和临床研究。: 阿米卡星对临床上最相关的 NTM 物种（复杂和）显示出中等活性。它与乙胺丁醇、氯法齐明和大环内酯类药物具有协同作用，这些组合在动物模型中有效。脂质体包封增加了阿米卡星的疗效。临床上，推荐的 15 毫克/千克静脉注射阿米卡星剂量并不能使所有患者达到 PK/PD 目标，并且在复杂和疾病中，对长期治疗结果的积极影响仍未得到证实。在对推荐的复杂肺部疾病治疗无反应的患者中，添加阿米卡星脂质体吸入混悬剂确实在短期和长期内都有效。其在复杂和肺部疾病中的最佳使用需要进一步评估。
