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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)
Monitor urine output, urinalysis, BUN, serum creatinine, peak and trough amikacin concentrations. Discontinue if any signs of ototoxicity.
Serum level monitoring for extended-interval dosing: Utilize Hartford nomogram
Consult pharmacist for level interpretation and dose individualization
Nephrotoxicity (non-oliguric): greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins
Vestibulocochlear toxicity (irreversible): greater risk with prolonged use, suggest audiology testing if prolonged use
Can exacerbate neuromuscular blockade, e.g. contraindicated in patients with myasthenia gravis
Enhanced nephrotoxic effect with concomitant use of other nephrotoxins
Enhanced ototoxicity with loop diuretics (e.g. furosemide). Non-depolarizing muscle relaxants may be potentiated.
Antimicrobial class: Aminoglycoside
Average serum half life: Neonates (birth weight <2kg):
PNA 1 to 3 days of age: 7.1 hours
PNA 4 to 7 days of age: 6.1 hours
PNA >7 days of age: 5.5 hours.
Neonates(birth weight >2kg):
PNA 1 to 4 days of age: 6.5 hours
PNA 4 to 7 days of age: 5.1 hours
PNA >7 days of age: 4.9 hours
Infants ≥20 days: 2.21 ± 0.15 hours.
Children <6 years: 2.04 ± 0.2 hours.
Children and Adolescents 4 to 16 years: 1.6 ± 0.4 hours
Route of Elimination: Urine (94% to 98%); excreted unchanged via glomerular filtration within 24 hours
