Amikacin

Monitor serum creatinine and urea 2-3 times/week. Discontinue if any signs of vestibulotoxicity or ototoxicity.

All aminoglycosides carry potential for cochlear, renal and vestibulotoxicity. If considering using amikacin, strongly consider ID consultation.

For once daily/extended interval dosing dosing:

• Peak levels are not recommended

• NO level is required in patients with normal renal function and therapy anticipated to be less than 8 days

• Patient populations to consider a serum concentration independent of duration of therapy:

  • critically ill patients
  • rapidly changing renal status
  • increased or rapidly changing Vd (e.g. ascities, burn)
  • serum creatinine is an unreliable indicator of renal function
  • concurrent nephrotoxic therapy (Amphotericin B, vancomycin, chemotherapy, furosemide, cyclosporine or tacrolimus etc.)

A single serum concentration can be drawn between 6 to 14 hours after the start of the aminoglycoside infusion (typically an 8-10 hour post concentration is drawn.)
This concentration is then divided by 2 and then plotted on the Hartford dosing nomogram.

• Contact Pharmacy to assist in arranging monitoring, level interpretation and dose individualization.

For conventional multiple times per day dosing:

• Target Peak 20-30 mg/L, Trough <4 mg/L. Peak levels usually not required but if drawn, record time of dose and time of level draw as accurately as possible.

• Contact pharmacy for monitoring set up, level interpretation and dose individualization
  NB: Trough level is 30-60min BEFORE next dose dose, and peak is 30-60min AFTER dose infused.

For Cystic Fibrosis modified extended interval dosing:

• Contact pharmacy for monitoring set up, level interpretation and dose individualization

For Intermittent OR Continuous dialysis:

• Contact pharmacy for monitoring set up, level interpretation and dose individualization