Low
NA
$60/day
Conventional Dosing
7.5 mg/kg q12h IV or IM
High Dose Extended Interval (HDEI)
15 mg/kg q24h IV or IM
Mycobacteria
7.5-10 mg/kg q24h
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).
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.
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.
Increased nephrotoxicity: amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin.
Increased ototoxicity: furosemide.
Increased risk of respiratory paralysis: neuromuscular blockade agents
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
