Amikacin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

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

Monitor creatinine closely (Pharmacist may order per MSH Policy).

Discontinue if any signs of ototoxicity.

Pharmacist will consult, adjust doses and order serum drug levels and renal function monitoring as per MSH Policy.

For indication specific peak and trough target levels, please refer to MSH Aminoglycoside Policy and consult pharmacy.

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