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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>NTM Antimicrobial Guide</title>
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<div class="container">
<a href="index.html" class="back-link">← Back to Home</a>
<h1>Table 4. Summary of Antimicrobial Dosing, Target Therapeutic Drug Monitoring Values, Adverse Effects, Drug Interactions, and Respective Management</h1>
<table>
<thead>
<tr>
<th>Antimicrobial</th>
<th>Dosing</th>
<th>Therapeutic Drug Monitoring Targets</th>
<th>Adverse Effects and Drug Interactions</th>
<th>Suggested Monitoring and Management</th>
</tr>
</thead>
<tbody>
<tr>
<td>Azithromycin</td>
<td>250–500 mg PO/IV daily; 500 mg 3x weekly</td>
<td>Cmax: 0.2–0.7 µg/mL</td>
<td>GI intolerance, reversible hearing loss, tinnitus, QTc prolongation, hypersensitivity, transient transaminitis</td>
<td>Clinical evaluation, LFTs at baseline and every 1–2 months, ECG if QTc-prolonging agents used. Hold for significant adverse events.</td>
</tr>
<tr>
<td>Clarithromycin</td>
<td>500 mg PO twice daily</td>
<td>Cmax: 2–5 µg/mL</td>
<td>GI intolerance, reversible hearing loss, tinnitus, QTc prolongation, CYP3A4 inhibition, drug interactions, hepatotoxicity (rare)</td>
<td>Clinical evaluation, LFTs at baseline and every 1–2 months, ECG if combined with QTc-prolonging agents. Adjust medications accordingly.</td>
</tr>
<tr>
<td>Rifampin</td>
<td>10 mg/kg PO daily (max 600 mg)</td>
<td>Cmax: 8–24 µg/mL</td>
<td>Hepatotoxicity, drug interactions (CYP inducer), thrombocytopenia, GI upset, orange discoloration of secretions</td>
<td>Clinical evaluation, LFTs every 1–2 months. Monitor for drug interactions.</td>
</tr>
<tr>
<td>Rifabutin</td>
<td>300 mg PO daily (dose adjust with interactions)</td>
<td>Cmax: 0.4–0.6 µg/mL</td>
<td>Neutropenia, uveitis, hepatotoxicity, drug interactions, orange discoloration of secretions</td>
<td>Clinical evaluation, CBC and LFTs every 1–2 months. Dose adjust with interacting agents.</td>
</tr>
<tr>
<td>Ethambutol</td>
<td>15–25 mg/kg PO daily</td>
<td>Cmax: 2–6 µg/mL</td>
<td>Optic neuritis, rash, arthralgia, hepatotoxicity</td>
<td>Clinical evaluation, baseline and monthly visual acuity and color vision testing, LFTs every 1–2 months.</td>
</tr>
<tr>
<td>Amikacin (IV)</td>
<td>15–20 mg/kg IV daily or 3x weekly</td>
<td>Peak: 35–45 µg/mL; Trough: <5 µg/mL</td>
<td>Nephrotoxicity, ototoxicity, vestibular toxicity</td>
<td>Clinical evaluation, baseline and periodic audiometry, renal function, monitor serum levels.</td>
</tr>
<tr>
<td>Amikacin (Inhaled)</td>
<td>590 mg nebulized daily</td>
<td>Not applicable</td>
<td>Ototoxicity, bronchospasm, oral candidiasis, dysphonia, hemoptysis</td>
<td>Baseline spirometry, monitor oral cavity discomfort, rechallenge after 1-week holiday if tolerated.</td>
</tr>
<tr>
<td>Streptomycin</td>
<td>10–15 mg/kg IV daily or 3x weekly</td>
<td>Peak: 20–30 µg/mL; Trough: <2 µg/mL</td>
<td>Nephrotoxicity, ototoxicity, vestibular toxicity</td>
<td>Baseline audiometry, renal function, monitor peaks/troughs, adjust dosing based on renal function.</td>
</tr>
<tr>
<td>Moxifloxacin</td>
<td>400 mg PO/IV daily</td>
<td>Cmax: 3–5 µg/mL</td>
<td>QTc prolongation, hepatitis, nausea, vomiting, tendinitis, aortic dissection (rare)</td>
<td>Clinical evaluation, ECG at baseline and regularly, Cr and LFTs every 1–2 months, electrolyte management.</td>
</tr>
<tr>
<td>Bedaquiline</td>
<td>400 mg PO daily for 14 days, then 200 mg three times weekly</td>
<td>QTc prolongation monitoring</td>
<td>QTc prolongation, hepatitis, elevated amylase, nausea, rash, joint pain</td>
<td>Clinical evaluation, ECG baseline and periodically, LFTs every 1–2 months, electrolyte management.</td>
</tr>
<tr>
<td>Linezolid</td>
<td>600 mg PO/IV twice daily</td>
<td>Cmax: 12–26 µg/mL</td>
<td>Myelosuppression, peripheral/optic neuropathy, serotonin syndrome</td>
<td>Clinical evaluation, CBC weekly, monitor for neuropathy, monitor for serotonin syndrome if combined with serotonergic agents.</td>
</tr>
<tr>
<td>Clofazimine</td>
<td>100 mg PO daily</td>
<td>Not established</td>
<td>Skin discoloration, GI intolerance, QTc prolongation, hepatotoxicity</td>
<td>Clinical evaluation, ECG baseline and periodically, LFTs every 1–2 months.</td>
</tr>
<tr>
<td>Trimethoprim-Sulfamethoxazole (TMP-SMX)</td>
<td>800/160 mg PO/IV twice daily</td>
<td>Adjust based on renal function</td>
<td>GI intolerance, cytopenias, hyperkalemia, renal injury, hypersensitivity, hepatitis</td>
<td>Clinical evaluation, Cr, electrolytes, LFTs, and CBC monthly. Discontinue for severe adverse events.</td>
</tr>
</tbody>
</table>
</div>
</body>
</html>