9
Table 3. Dosing Guidelines for Drugs Used in the
Management of NTM Pulmonary Disease
Drug Daily Dosing
Thrice
Weekly
Dosing
Hepatic
Impairment
Renal
Impairment
Parenteral
Amikacin (IV) 10–15 mg/kg
per day
c
,
adjusted
according
to drug level
monitoring
d
15–25 mg/kg
per day
c
,
adjusted
according
to drug level
monitoring
d
N/A Reduce dose or
increase dosing
interval (eg,
15 mg/kg, 2–3
times per week)
Cefoxitin (IV) 2–4 g 2–3
times daily
(maximum
daily dose is
12 g/day)
N/A N/A Reduce dose or
increase dosing
interval
Imipenem (IV) 500–1000 mg,
2–3 times per
day
N/A N/A Reduce dose or
increase dosing
interval
Streptomycin
(IV or IM)
10–15 mg/kg
per day,
adjusted
according
to drug level
monitoring
15–25 mg/kg
per day,
adjusted
according
to drug level
monitoring
N/A Reduce dose or
increase dosing
interval (eg,
15 mg/kg, 2–3
times per week)
Tigecycline (IV) 25–50 mg once
or twice per
day
b
N/A 25 mg once
or twice daily
per day in
severe hepatic
impairment
N/A
Inhalation
Amikacin
liposome
inhalation
suspension
590 mg per day N/A N/A N/A
Amikacin,
parenteral
formulation
250–500 mg
per day
N/A N/A N/A
a
Clofazimine availability varies by country. In the United States, an investigational new drug
application is required.
b
Most experts recommend once daily dosing of linezolid and tigecycline due to the high rate of
drug-related adverse reactions associated with twice daily dosing.
c
e use of the described regimens for 15 weeks was associated with permanent ototoxicity in
approximately one third of patients, and the risk was associated with age and cumulative dose.
Given the high rates of ototoxicity, risks and benefits should be carefully considered in light of the
goals of therapy. Clinicians should consider lower dose ranges and probably rely on intermittent
dosing when more prolonged therapy is employed.
d
Drug level monitoring : Trough <5 mg/L; Peak with daily dosing 35–45 μg/mL; Peak with
intermittent dosing 65–80 μg/mL.
(cont'd)
