Amikacin

C difficile risk
Low
Oral Bioavailability
N/A
Cost
$

Dosing

Consult pharmacy for dosing recommendations

No adjustment required

Multiple Daily Dose (MDD) Amikacin 7.5 mg/kg q12h IV or IM

Once Daily (OD) Dose Amikacin 15 mg/kg q24h IV or IM

Mycobacteria 7.5-10 mg/kg q24h

General Information

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 species (e.g. M. abscessus).

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

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

Consult pharmacist for level interpretation and dose individualization

For once daily dosing: Target Trough <1 mg/L. Peak levels not recommended.

Nephrotoxicity (non-oliguric)

  • Less common with once daily dosing

  • Avoid concomitant nephrotoxins

  • Greater toxicity with longer duration and supratherapeutic trough levels

Vestibulocochlear toxicity

  • Irreversible

  • Audiology testing required for prolonged use

Other

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

Increased nephrotoxicity with:

  • Amphotericin B

  • Cyclosporine

  • Cisplatin

  • NSAIDS

  • Contrast dye

  • Vancomycin

Increased ototoxicity with:

  • Furosemide

Respiratory paralysis with:

  • Neuromuscular blockade agents

Formal audiology assessment required if planning to use aminoglycoside for >7d or if symptoms develop.

Inform patient of risk of ototoxicity and to report any symptoms.

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2.5 hours

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic