Antimicrobials
Amikacin

Amikacin

Low
N/A
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status No

SA None

PharmaCare Coverage None

Outpatient Cost 250mg/ml inj - $91.69-105.91/vial (2ml)

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 (IV)

  • includes acute kidney injury, acute tubular necrosis and distal tubular dysfunction
  • sx: polyuria, hypomagnesemia, hypokalemia, hypocalcemia, hypophosphatemia and urine sediment with mild proteinuria, hyaline and granular casts
  • caused by distal tubular damage
  • amikacin has less nephrotoxic potential than tobramycin and gentamicin
  • onset: usually after 5-7 days of therapy
  • usually reversible
  • plasma creatinine usually returns to prior baseline within 21 days after discontinuation, but resolution of acute episode may be delayed and incomplete
  • adults: 10-20%

Ototoxicity (IV)

  • may cause vestibular or cochlear damage
  • vestibular toxicity sx: vertigo, disequilibrium, lightheadedness, nausea, vomiting and ataxia
  • cochlear toxicity sx: tinnitus and hearing loss
  • can be transient or irreversible
  • prevention: N-acetylcysteine use in patients with long-term aminoglycosides and/or end-stage kidney disease

Neuromuscular blockade (IV)

  • rare
  • most patients have disease states and/or concomitant drug therapy that interfere with neuromuscular transmission
  • avoid aminoglycosides 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

Antimicrobial class: Aminoglycoside

Pregnancy category: D

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)

Average serum half life: 2.5 hr

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate