Amikacin - Renal - Adult Dosing

  • Use ideal body weight for dosing in most cases.

  • Use adjusted body weight for obese patients (BMI ≥ 30 kg/m²)

  • Aminoglycoside dosing & monitoring per pharmacy available. Order in CareConnect.

CrCl > 60 mL/min

15-20 mg/kg/dose IV Q24h

CrCl 40 - 60 mL/min

10-15 mg/kg/dose IV Q36h

CrCl 20 - 40 mL/min

10-15 mg/kg/dose IV Q48h

CrCl < 20 mL/min (ESRD not on HD)

Call pharmacy

Note

Extended dosing allows for high peak to MIC ratios potentially improving efficacy and reducing the risk of nephro- and ototoxicity. An extended-interval level drawn between 6-14 hours (after the start of the infusion) is recommended any time after the first dose. Peak levels are not necessary and trough levels should be undetectable. Call pharmacy for assessment of aminoglycoside levels.

CrCl > 60 mL/min

7.5 mg/kg/dose IV Q12h

CrCl 40 - 60 mL/min

5-7.5 mg/kg/dose IV Q12-Q24h

CrCl 20 - 40 mL/min

5 mg/kg/dose IV Q24h-Q48h

CrCl < 20 mL/min (ESRD not on HD)

2.5-5 mg/kg/dose IV Q48h-Q72h

Note

Target amikacin levels: PEAK = 25-35 mg/L and TROUGH = < 5 mg/L. Peak levels should be drawn ½ hour following a ½ hour infusion. Trough levels should be obtained prior to the fourth dose of the regimen.

HD

5 - 7.5 mg/kg IV PHD

CRRT

10 mg/kg x1 then 5 - 7.5mg/kg IV Q24-48h