Version June 2024
| Agent | Dose | Comments |
| Intravenous agents | ||
| Amikacin | Initial:
| Subsequently adjust the dose to provide peak serum levels above the amikacin MIC (preferably at least 2 to 3 times the MIC) while avoiding peak levels >35 mcg/mL.* |
| Imipenem | 0.5 to 1 g intravenously two or three times daily¶ | We prefer twice-daily dosing. |
| Cefoxitin | 6 to 8 g intravenously per day in divided doses¶ | We typically use 4 g twice daily. |
| Tigecycline | 25 mg to 50 mg intravenously once to twice daily | Dosing is often limited by nausea and vomiting. We typically use a maximum daily dose of 50 mg. Patients generally cannot tolerate 50 mg twice daily for a prolonged period. |
| Oral agents | ||
| Azithromycin | 250 to 500 mg orally once daily or 500 mg three times per week | |
| Clarithromycin | 500 mg twice daily administered orally every day or 3 times per week | |
| Clofazimine | 100 mg orally once daily | In the United States, clofazimine is not commercially available but can be requested by filing a single-patient investigational new drug application with the FDA. |
| Omadacycline | 300 mg orally once daily | This can also be administered intravenously (100 mg once daily). |
| Tedizolid | 200 mg orally once daily | |
| Linezolid | 600 mg orally once daily | For those who cannot tolerate 600 mg daily, we often suggest they cut the tablet in half and take 300 mg orally once daily. |
| Bedaquiline | 400 mg orally once daily for 2 weeks then 200 mg orally three times per week | |
| Inhaled agent | ||
| Amikacin | Parenteral formulation: 250 to 500 mg inhaled once daily Amikacin liposome inhalation suspension: 590 mg inhaled once daily | |
MIC: minimum inhibitory concentration; FDA: US Food and Drug Administration.
* The optimal dosing and peak levels of amikacin for M. abscessus infection are not established and remain controversial; in particular, the maximum peak levels for three times weekly dosing is uncertain. At 25 mg/kg per dose, peak levels would likely exceed 35 mcg/mL. Nevertheless, the author's practice is to maintain peak levels ≤35 mcg/mL regardless of dosing interval. For any dosing approach, careful monitoring for amikacin toxicity (especially ototoxicity) is critical.
¶ We typically use twice-daily dosing. Dosing of intravenous medications three times a day is generally impractical for most patients, particularly those who receive their medications at an infusion center.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
