I experienced no debilitating side effects from the Big 3 meds or nebulized amikacin, just occasional nausea probably from the rifampin which I treated with ginger ale and ginger chews. Since it's localized to the lungs, nebulized amikacin diluted with .9 % saline might be easier to tolerate than IV infusions, and there's no PICC line to worry about. Arikayce, which is amikacin optimized for inhalation, could be even better, though cost / insurance approval could be an issue since the usual standard is to start that medication after six months of Big 3 therapy, and if sputum results are still positive. Good luck.