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Investigational Nanomedicines in 2016: A Review of Nanotherapeutics Currently Undergoing Clinical Trials *
Published in Valerio Voliani, Nanomaterials and Neoplasms, 2021
Joseph M. Caster, Artish N. Patel, Tian Zhang, Andrew Wang
Amikacin is a potent aminoglycoside antibiotic which is useful for the treatment of multidrug resistant Gram-negative bacteria as well as resistant strains of Mycobacterium tuberculosis [60, 61]. Like other aminoglycosides, significant toxicities include renal and neurologic toxicity. Amikacin is also limited by a relatively short half-life of 2–3 h [62]. Amikacin is generally reserved for the treatment of severe infections and requires frequent blood level monitoring. Arikayce is a liposomal formulation of amikacin designed as an inhaled medication for the treatment of drug resistant pseudomonal infections in patients with CF. Arikayce significantly improved the drug half-life and in a phase II trial, there was no notable difference in toxicity between the liposomal drug treatment and placebo [63]. The FDA has granted fast track designation to Arikace based on the results of a noninferiority phase 3 trial of 302 CF patients with chronic pseudamonal infections randomized to Arikace or inhaled tobramycin.
Drug-Resistant Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Keertan Dheda, Aliasgar Esmail, Anzaan Dippenaar, Robin Warren, Jennifer Furin, Christoph Lange
SLID, with appropriate monitoring, can still be considered in patients with fluoroquinolone-resistant MDR-TB, but where resources permit, a subcutaneous tunneled intravenous catheter should be inserted. Where this is unavailable, it is recommend that amikacin be given intramuscularly together with a local anesthetic, which seems feasible and does not affect the pharmacokinetics of the drug.171 The use of kanamycin is no longer supported given its lack of association with better outcomes (low quality evidence); the same for capreomycin as it was associated with increased mortality. Hearing loss should be monitored, and it has become apparent that subclinical hearing loss is common in populations in TB-endemic countries because of poor access to health care during childhood years (thus access to regular testing is mandatory if injectables are to be used). SLIDs can be dosed at 3 times a week, where appropriate, to minimize toxicity.
Inhalation Drug Products Containing Nanomaterials
Published in Anthony J. Hickey, Sandro R.P. da Rocha, Pharmaceutical Inhalation Aerosol Technology, 2019
Sandro R.P. da Rocha, Rodrigo S. Heyder, Elizabeth R. Bielski, Ailin Guo, Martina Steinmaurer, Joshua J. Reineke
Amikacin is an aminoglycoside antibiotic used for the treatment of multidrug resistant gram-negative bacteria (Pseudomonas aeruginosa associated with cystic fibrosis) and resistant strains of Mycobacterium tuberculosis (Caster et al. 2017, Elhissi 2017). It irreversibly binds to 30S subunit of bacterial ribosomes blocking protein synthesis (Ehsan and Clancy 2015). It is generally reserved for severe infections, can induce severe renal and neurologic toxicity, requiring frequent blood monitoring, and has a relatively short half-life (Caster et al. 2017, Elhissi 2017). The LAI (Arikace™, Arikayce) was designed with the hope to address these limitations.
The treatment of nosocomial meningitis and brain abscess by carbapenem-resistant Klebsiella pneumonia
Published in British Journal of Neurosurgery, 2023
In our case the CRKP was sensitive to amikacin, tigecycline, and sulfamethoxazole. Tigecycline and amikacin don’t penetrate the blood-brain barrier; polymyxin and avibactam were not available in our hospital; minocycline and sulfamethoxazole have good penetration rate but they are oral drugs, while gastrointestinal dysfunction of critical patients means oral drug absorption can be unpredictable. This left intravenous combined with intrathecal antibiotics. Antimicrobial agents administered by intraventricular route was recommended by Infectious Diseases Society of America.10 The daily intraventricular dose of amikacin is 5–50 mg. In our case, consider the resistance of CRKP to amikacin, we choice high dose of amikacin and got the acceptation from the patient. The high dose of amikacin (120 mg daily) was well tolerated and no serious side effects shown during or after the treatment.
Multifocal Serpiginoid Choroiditis Due to Mycobacterium Mageritense following Laparoscopic Hysterectomy in an Immunocompetent Host
Published in Ocular Immunology and Inflammation, 2023
Shrey Maheshwari, Shweta Parakh, Shrutanjoy M Das, Alok Ahuja, Shashi Nath Jha, Rupesh Agrawal, Vishali Gupta, Saurabh Luthra
During the subsequent follow-up, fever had persisted, and vision had deteriorated along with increased yellowish lesions at the posterior pole along with a corresponding increase in subretinal fluid on SD-OCT (Figure 1d). Repeated blood cultures had eventually detected Mycobacterium mageritense using Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) (VITEK MS, bioMerieux, Marcy l’Etoile, France). The isolate was sensitive to amikacin, imipenem, ciprofloxacin, trimethoprim-sulfamethoxazole, and resistant to clarithromycin. Patient was administered intravenous amikacin according to the sensitivity profile of the detected organism. However, a month after starting this treatment, the patient was shifted to oral meropenem, ciprofloxacin and trimethoprim-sulfamethoxazole in view of deranged liver function. After episodic waxing and waning, the fever finally subsided after two months. At this visit, subretinal fluid had resolved on SD-OCT (Figure 1e).
Single-dose intravesical amikacin instillation for pyocystis in a patient with autonomic dysreflexia: A case report
Published in The Journal of Spinal Cord Medicine, 2022
Erin Sherwin, Cynthia King, Howard Hasen, Shari May
In our patient, we administered a one-time intravesical instillation with amikacin given that the patient was anuric and the concomitant IV antibiotics he was receiving – vancomycin and ceftriaxone – were unlikely to penetrate the site of infection despite susceptibility to ceftriaxone. The recommended dose of amikacin should be 10 times the MIC of the pathogen in question.13 Amikacin 25 mg/100 mL solution was instilled intravesically and was left to dwell for approximately 2 h. This dose was sufficiently above the goal of 10 times the MIC as the reported MIC of the E. coli isolate was ≤ 8 mg/L. Amikacin serum concentrations were not measured for this patient. Toxicities commonly associated with aminoglycosides are ototoxicity and nephrotoxicity. Incidences of perception deafness have been reported in the literature in cases where patients received regular irrigations for long periods of time (weeks to months).14,15 Bladder irritation has also been reported as a potential adverse effect.16 Our patient remained stable during and after the procedure with no adverse events.