← Back to Home

Table 4. Summary of Antimicrobial Dosing, Target Therapeutic Drug Monitoring Values, Adverse Effects, Drug Interactions, and Respective Management

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