Starting Treatment with Inhaled Amikacin (Arikayce)

People with cystic fibrosis (CF) are no strangers to antibiotics. Some antibiotics are well-known in the CF sphere as they are commonly used. One less-known antibiotic is amikacin, which is currently available in the United States as an injection or as an inhaled suspension. The inhaled product, Arikayce, the topic of this article, is used to treat particularly resistant infections caused by Mycobacterium Avium Complex (MAC).¹

What is MAC?

MAC is a type of serious infection caused by different types of bacteria. The bacteria are found in the environment, such as soil and water. The infection is not contagious and cannot be spread person-to-person. For most people, these bacteria do not cause problems. However, people with certain medical conditions – for example, cystic fibrosis – have the potential for serious complications.² MAC can cause different syndromes, manifesting as pulmonary disease, skin infections, or disseminated (all over the body) disease.³ For people with CF, the main concern is pulmonary MAC.

Pulmonary MAC

Overall, symptoms of MAC are not very specific. Symptoms can include:

• Chest discomfort
• Shortness of breath
• Fatigue
• Cough, with or without blood

If you have any of the above symptoms, your doctor will run some imaging tests (such as a chest x-ray) and take sputum samples to confirm the type of bacteria infecting your airways.²

Treating MAC

Treating pulmonary MAC typically requires use of antibiotics for an extended period of time. Usually, the regimen includes the macrolide class of antibiotics (for example, azithromycin) in addition to rifampin and ethambutol for several months. The treatment is usually continued for an additional 12 months after there are no bacteria detected in the sputum. A doctor will determine how long you should continue treatment.^4,5

However, sometimes, common treatment regimens do not work, and an additional agent needs to be added to the regimen. One of these potential drugs is Arikayce, which is indicated in the United States for people who have no treatment alternatives. It is used in combination with standard antibiotic therapy in people who don’t respond to 6 months of regular antibiotic treatment.^4,5

How is Arikayce used?

Arikayce comes formulated as a suspension for inhalation. The typical dose is one vial inhaled once daily.⁶ Always consult your doctor to determine correct dosing.

The medication must be used with a specific nebulizer, the Lamira Nebulizer System, over a period of 14-20 minutes.⁶ It is important not to stop any other antibiotics being used to treat MAC when Arikayce is initiated.⁶

Side effects of Arikayce

Arikayce is in the class of medications referred to as aminoglycosides, which have the potential to cause serious side effects. Some of the serious side effects include:^6,7

• Hearing loss or ear ringing: these side effects are collectively referred to as “ototoxicity”. It occurs in approximately 17% of people who take the medication. This side effect can also manifest as dizziness or fainting, which is attributed to problems with the inner ear. Your doctor will monitor you the first weeks and months of starting this medication, as the hearing loss side effect is usually not reversible.
• Kidney dysfunction: people with kidney dysfunction are usually not recommended to start this drug because of this potential side effect.

Starting a new medication – especially one that is not commonly used – can be a scary experience. Connecting with individuals who have been on treatment can help minimize fears.

Have you taken amikacin (Arikayce), or any other aminoglycoside, to treat MAC? Share your experiences below!