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).

IV only: Tier 2 Protected Antimicrobial Broad spectrum, but 1st line for common infections, comes with a high risk of poor stewardship if initial workup and follow-up are not in place

Strategies Used:

1. Appropriate workup initially
2. Pharmacists audit/de-escalate
3. Set EBM Duration

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

Hartford Nomogram

• Divide level by 2 to plot on graph
• Obtain Level 6-14 hours after the start of the 1st infusion and plot on nomogram
• Nomogram for 15mg/kg
• If level falls on the line: choose longer regimen
• If unable to be obtain on nomogram: use traditional dosing

Traditional Dosing

Trough level is 0-60min before a dose (usually pre-4th), and peak is 30-60min after dose infused (usually post-3rd).

In critically ill patients, consider checking peak level after the 1st dose as volume of distribution and renal function may change rapidly.

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

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

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

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2.5 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate