Amikacin

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$

Dosing

Adult

Traditional Dose Amikacin 7.5 mg/kg q12h IV or IM

Extended Interval Dose Amikacin 15 mg/kg q24h IV or IM

Mycobacteria 7.5-10 mg/kg q24h

Recommend dosing per Pharmacy

Restricted Use

Organisms with suspected/documented resistance to gentamicin and tobramycin.

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

Laboratory

  •  Monitor creatinine at least 2 times/week. Discontinue if any signs of nephro or ototoxicity.

  •  For traditional 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 extended interval dosing: Target Trough <1 mg/L; Peak levels not recommended.

Clinical

  • Baseline and periodic hearing and vestibular function (questioning audiologic testing with prolonged therapy)

Adverse Effects

  • Nephrotoxicity

  • Auditory toxicity

  • Vestibular toxicity

  • Neuromuscular blockade

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

Pharmacology

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2.5 hours

Biliary penetration: Moderate

CSF penetration: Poor

Urine penetration: Therapeutic