Amikacin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Spectrum Of Activity

Dosing

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

General Information

Common Usage

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).

Drug Monitoring

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.

Adverse Effects

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.

Major Interactions

Increased nephrotoxicity with: amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin.

Increased ototoxicity: furosemide.

Neuromuscular blockade agents- respiratory paralysis.

Additional Information

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

Pharmacology

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2.5

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic