Amikacin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$162.00/day

Dosing

Height Males Females
150.0 cm 50.0 kg 45.5 kg
152.5 cm 52.3 kg 47.8 kg
155.0 cm 54.6 kg 50.1 kg
157.5 cm 56.9 kg 52.4 kg
160.0 cm 59.2 kg 54.7 kg
162.5 cm 61.5 kg 57.0 kg
165.0 cm 63.8 kg 59.3 kg
167.5 cm 66.1 kg 61.6 kg
170.0 cm 68.4 kg 63.9 kg
172.5 cm 70.7 kg 66.2 kg
175.0 cm 73.0 kg 68.5 kg
177.5 cm 75.3 kg 70.8 kg
180.0 cm 77.6 kg 73.1 kg
182.5 cm 79.9 kg 75.4 kg
185.0 cm 82.2 kg 77.7 kg
187.5 cm 84.5 kg 80.0 kg
190.0 cm 86.8 kg 82.3 kg

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 species (e.g. M. abscessus).

Drug Monitoring

Serum creatinine whenever initiating any aminoglycoside.

Creatinine and trough level should be monitored AT LEAST twice weekly; more often if unstable renal function or addition of nephrotoxic medications.

Trough level should be collected 30 min prior to scheduled dose

Target Trough Level
Once daily/extended interval dosing: < 4 mg/L

Multiple daily dosing: < 4 mg/L

Amikacin Peaks
Are not used in once daily/extended interval regimens.

For multiple daily dosing regimens, peaks not commonly measured but if required are collected 30-60 min after infusion complete

Adverse Effects

Risk of toxicity with aminoglycosides increases with duration of therapy even if levels are maintained in appropriate therapeutic range. Therapy should be kept to minimum duration appropriate for indication to minimize this risk.

Nephrotoxicity

  •  Less common with once daily dosing.

  •  Avoid concomitant nephrotoxins.

  •  Greater toxicity with longer duration and supratherapeutic trough levels.

Vestibulocochlear toxicity

  •  Irreversible

  •  Audiology testing recommended for prolonged use

Other

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

Major Interactions

Increased nephrotoxicity with:

  •  Amphotericin B

  •  Cyclosporine

  •  Cisplatin

  •  NSAIDS

  •  Contrast dye

  •  Vancomycin

Increased ototoxicity with:

  •  Furosemide

Respiratory paralysis with:

  •  Neuromuscular blockade agents

Additional Information

IV Administration
Dilute in 100-250 mL NS or D5W; administer over 30-60 min

EH Prescribing Restrictions

  • Unrestricted

  • Pharmacist Reviews Therapy

Community IV Formulary (Metro Region)
YES

See EH Intranet for Full Aminoglycoside dosing policy: PHA-124 Aminoglycoside Antibiotic Monitoring (Adult)

Pharmacology

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