Amikacin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$60/day

Spectrum Of Activity

Dosing

Cystic fibrosis pulmonary infection: 30 mg/kg/DAY divided q8-24h (extended interval preferred).

Treatment of Nontuberculous Mycobacterial Infections: 15- 30 mg/kg/DAY divided q12-24h; maximum 1.5 g/DAY

15- 22.5 mg/kg/DAY divided q8h; maximum 1.5 g/DAY

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

General Information

Common Usage

Therapy of gram negative organisms resistant to gentamicin and tobramycin but susceptible to amikacin (HAP, UTI, other).<br>As combination therapy for the treatment of some Mycobacteria spp (i.e. M. abscessus).

Drug Monitoring

Monitor urine output, urinalysis, BUN, serum creatinine, peak and trough amikacin concentrations. Discontinue if any signs of ototoxicity.

Serum level monitoring for conventional dosing: Draw peak levels 30 minutes after the end of the infusion and trough levels within 30 minutes before the next dose. UTI: Peak levels 15-20 mcg/mL and trough < 4 mg/L (if level monitoring is indicated), Serious infections: Peak 20-40 mg/L and trough < 8 mg/L,.

Serum level monitoring for extended-interval dosing: Target trough <2 mg/L; Peak levels not generally recommended.

Consult pharmacist for level interpretation and dose individualization

Adverse Effects

Nephrotoxicity (non-oliguric)- greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins

Vestibulocochlear toxicity (irreversible)- greater risk with prolonged use, sugest audiology testing if prolonged use

Can exacerbate neuromuscular blockade- e.g. contraindicated in patients with myasthenia gravis.

Major Interactions

Enhanced nephrotoxic effect with concomitant use of other nephrotoxins .

Enhanced ototoxicity with loop diuretics (e.g. furosemide). <br> Non-depolarizing muscle relaxants may be potentiated.

Pharmacology

Antimicrobial class: Aminoglycoside

Average serum half life: Neonates (birth weight <2kg):

  • PNA 1 to 3 days of age: 7.1 hours

  • PNA 4 to 7 days of age: 6.1 hours

  • PNA >7 days of age: 5.5 hours.

Neonates(birth weight >2kg):

  • PNA 1 to 4 days of age: 6.5 hours

  • PNA 4 to 7 days of age: 5.1 hours

  • PNA >7 days of age: 4.9 hours

Infants ≥20 days: 2.21 ± 0.15 hours.

  • Children <6 years: 2.04 ± 0.2 hours.

  • Children and Adolescents 4 to 16 years: 1.6 ± 0.4 hours

Route of Elimination: Urine (94% to 98%); excreted unchanged via glomerular filtration within 24 hours