Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Amikacin

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$ + monitoring

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

Pediatric

Cystic Fibrosis
30 mg mg/kg q24h

Traditional Dosing
15 mg/kg/day divided q8-12 hours

Adult

CrCl > 30 mL/minOnce Daily (OD) Dose Amikacin
15 mg/kg q24h IV or IM

Mycobacteria
10-15 mg/kg q24h or 15-25 mg/kg three times weekly

Cystic Fibrosis
30 mg mg/kg q24h

Hepatic

No adjustment required

General Information

Common Usage

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

Drug Monitoring

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. Use hartford nomogram.

Adverse Effects

Adverse Effects

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.

Major Interactions

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

Additional Information

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. Ototoxicity includes both vestibular and cochlear toxicity.

Pharmacology

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