Kinetics and toxicity of liposomal and conventional amikacin in a patient with multidrug-resistant tuberculosis

The pharmacokinetics and toxicity of liposomal amikacin in a patient treate d for advanced pulmonary multidrug-resistant tuberculosis are described. A dose of 20 mg/kg of liposomal amikacin was given on alternate days for 14 d ays and weekly thereafter for 9 weeks, for a total dose of 20.1 g in 17 div ided doses. Accumulation occurred with alternate-day, but not weekly, dosin g. The serum levels of amikacin obtained with the liposomal preparation wer e considerably greater than those obtained with the conventional preparatio n (range, 81-457 mg/l vs. 4.1-37.7 mg/l). The liposomal amikacin was well t olerated and led to clinical improvement, but it failed to achieve a microb iological response. The patient's sputum remained smear- and culture-positi ve during the treatment period with liposomal amikacin and for 9 months aft erward.