Amikacin - Renal Dosing

In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.

If worsening renal function, actual GFR is likely lower than calculated.

If improving renal function, actual GFR is likely higher than calculated eGFR.

eGFR >60

15mg/kg dosing body weight (DBW) IV q24h

eGFR 40-59

15mg/kg dosing body weight (DBW) IV q36h

eGFR 20 - 39

15mg/kg dosing body weight (DBW) IV q48h

eGFR < 20

Consult Pharmacy for specific dosing recommendations

eGFR 50 - 75

7.5mg/kg dosing body weight (DBW) IV q12h

eGFR 40 - 50

7.5mg/kg dosing body weight (DBW) IV q16h

eGFR 25 - 40

7.5mg/kg dosing body weight (DBW) IV q24h

eGFR 15 - 25

7.5mg/kg dosing body weight (DBW) IV q36h

eGFR 10 - 15

Only use if no alternatives: 7.5mg/kg dosing body weight (DBW) IV q48h

eGFR 0 - 10

Consult Pharmacy for specific dosing recommendations

Contact Pharmacy for dosing assessment

AVOID use of aminoglycosides in patients receiving intermittent dialysis, if possible.

5-7.5 mg/kg load on day 1then 5-7.5 mg/kg after dialysis for each intradialytic period.

Check levels pre-dialysis.

Readminister post dialysis if less than 4mg/L

10 mg/kg load then 7.5 mg/kg q24h