Multiple Daily Dose (MDD) Amikacin 5 mg/kg q8h IV or IM Once Daily (OD) Dose Amikacin 15 mg/kg q24h IV or IM Mycobacteria 7.5-10 mg/kg q24h
No adjustment required
Therapy of gram negative organisms resistant to gentamicin and tobramycin but susceptible to amikacin (HAP, UTI, other).
As combination therapy for the treatment of some Mycobacteria spp (i.e. M. abscessus).
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
For BID dosing: Target Peak 15-30 mg/L, Trough <5 mg/L. Peak levels usually not required but if drawn record time of dose and time of level draw as accurately as possible.
Consult pharmacist for level interpretation and dose individualization
For once daily dosing: Target Trough <1 mg/L; Peak levels not recommended.
Nephrotoxicity (non-oliguric)- less common with once daily dosing; greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins
Vestibulocochlear toxicity (irreversible)- require audiology testing if prolonged use
Can exacerbate neuromuscular blockade- e.g. contraindicated in patients with myasthenia gravis.
Increased nephrotoxicity with: amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin.
Increased ototoxicity: furosemide.
Neuromuscular blockade agents- respiratory paralysis.
Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop
Inform patient of risk of ototoxicity to report any symptoms
Contraindicated in patients with myasthenia gravis
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2.5
Biliary penetration: Moderate
CSF penetration: Poor
Urine penetration: Therapeutic
Lung penetration: Therapeutic