C. diff Risk


Oral Bioavailability


Approximate Cost




Conventional Dosing
7.5 mg/kg q12h IV or IM

High Dose Extended Interval (HDEI)
15 mg/kg q24h IV or IM

7.5-10 mg/kg q24h


No adjustment required

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

Consult pharmacist for level interpretation and dose individualization.

HDEI dosing
Target Trough <1 mg/L; Peak levels not recommended.

Conventional dosing
Trough <5 mg/L. Target Peak 15-30 mg/L; peak levels usually not required but if drawn record time of dose and time of level draw as accurately as possible.

Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.

Adverse Effects

Nephrotoxicity (non-oliguric)- less common with once daily dosing; greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins

Vestibulocochlear toxicity (irreversible)- require audiology testing if prolonged use

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

Major Interactions

Increased nephrotoxicity: amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin.

Increased ototoxicity: furosemide.

Increased risk of respiratory paralysis: neuromuscular blockade agents

Additional Information

Formal audiology assessment at baseline if planning to use aminoglycoside for >7d or if symptoms develop

Inform patient of risk of ototoxicity and to report any symptoms (oscillopsia, imbalance, hearing loss, tinnitus)


Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2.5

Urine penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate

Lung penetration: Therapeutic