P163\u2005Survey on use and perception of amikacin for treatment of Mycobacterium avium Complex lung disease in the UK

Abstract

Background and Aim The British Thoracic Society guidelines for the management of NTM lung disease recommend the use of amikacin as part of multi-drug therapy for treatment of severe and clarithromycin-resistant Mycobacterium avium complex lung disease (MACLD). We surveyed physicians regarding the use of amikacin to treat of MACLD including when amikacin treatment is initiated, preferred route of administration (intravenous or nebulized), expected outcomes, and safety concerns. Methods An anonymised online survey (2019) consisting of primarily open ended and 5-point Likert scale-based (eg, unlikely to likely, less significant to more significant) questions was used to collect responses from UK respiratory consultants with experience managing MACLD. Results The survey was completed by 18 physicians with ≥5 years of experience in managing MACLD; most (72%; n=13/18) routinely managed ≥10 patients each year with MACLD. Respondents (44%, n=8) would initiate amikacin in treatment naive patients mainly in severe disease, such as with cavitation or significant degree of inflammatory change in CT scans, with 63% (n=5) preferring the use of nebulised amikacin. Respondents (n=17/18) would consider initiating amikacin in on average 48% of their MACLD patients who failed initial therapy, with 76% of respondents (n=13/17) preferring nebulised amikacin. Of the respondents (n=4/17) that would choose intravenous amikacin as their preferred route of administration, 75% (n=3) gave ‘efficacy’ as the reason. Respondents stated that administrating amikacin (either IV or nebulised) is fairly likely to lead to increased control of symptoms, halting of cavity progression, reduced microbiological burden, and culture conversion. When initiating amikacin, respondents had most significant safety concerns regarding ototoxicity (figure 1) and all respondents further emphasised ototoxicity as a safety concern in their free language response. All respondents stated that they would initiate amikacin therapy more often if the safety concerns were less significant. Conclusion Surveyed physicians use amikacin as part of a multi-drug regimen in approximately half of patients who have failed initial therapy, with nebulised amikacin as their preferred route of administration. Respondents had significant concerns regarding ototoxicity when amikacin was initiated. There was a consensus that physicians would initiate amikacin more often to achieve better outcomes for patients if the safety profile of amikacin was of a lesser concern.