Amikacin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Reminder Amikacin levels cannot be processed in house and must be sent out. Expect a turn around time of approximatley 48 hours.

Note

  • Use ideal body weight for dosing in most cases.

  • Use adjusted body weight for obese patients (BMI ≥30 kg/m2) Multiple Daily Dose Amikacin 7.5 mg/kg every12 hr IV or IM Once Daily Dose Amikacin (Preferred) 15 mg/kg every 24 hr IV or IM Mycobacteria 7.5-10 mg/kg every 24 hr

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 species (e.g. M. abscessus).

Drug Monitoring

Lab

  • 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.

Clinical

  • Baseline and periodic hearing and vestibular funtion

Adverse Effects

Nephrotoxicity (non-oliguric)

  •  Less common with once daily dosing

  •  Avoid concomitant nephrotoxins

  •  Greater toxicity with longer duration and supratherapeutic trough levels

Vestibulocochlear toxicity

  •  Irreversible

  •  Audiology testing required for prolonged use

Other

  •  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 with:

  •  Furosemide

Respiratory paralysis with:

  •  Neuromuscular blockade agents

Additional Information

Formal audiology assessment required if planning to use aminoglycoside for >7d or if symptoms develop.

Inform patient of risk of ototoxicity and to report any symptoms.

Pharmacology

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2.5 hours

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic