For patients greater than 30% above their Ideal Body weight (IBW), aminoglycosides should be dosed based on an adjusted /obese body weight (OBW). See Policy PHA-161 or Contact Pharmacy for details.
Multiple Daily Dose (MDD) Amikacin 7.5 mg/kg q12h IV or IM
Once Daily (OD) Dose Amikacin 15 mg/kg q24h IV or IM
Mycobacteria 7.5-10 mg/kg q24h
IBW = Ideal Body Weight ABW = Actual Body Weight OBW = Obese Body weight (aka dosing weight)
Males IBW in kg = 50 + 0.9 (height in cm - 150)
Females IBW in kg = 45.5 + 0.9 (height in cm - 150)
See nomogram section for IBW table
Use the Following Weights for Dosing Purposes (Round all doses to the nearest 25 mg)
If ABW is < 30% above IBW : Use ABW If ABW is > 30% above IBW: Calculate OBW
OBW in kg = IBW + 0.4(ABW - IBW)
Male, Height = 170cmIBW = 50 + 0.9(170-150) = 68 kg
If ABW = 100 kg OBW = 68 + 0.4 (100 -68) = 81 kg
If ABW = 60 kg , he is non-obese and ABW of 60 kg should be used for dosing.
eGFR less than 20eGFR 20-40eGFR 41 - 60eGFR > 60PHARMACIST CONSULT RECOMMENDED
5 mg/kg of calculated weight x 1 dose then re-dose when level falls below 4 mg/LPHARMACIST CONSULT RECOMMENDED
ONCE DAILY 15 mg/kg of calculated weight q48h
MULTIPLE DAILY 5 -7.5 mg/kg of calculated weight q24hPHARMACIST CONSULT RECOMMENDED
ONCE DAILY 15 mg/kg of calculated weight q36h
MULTIPLE DAILY 5 mg/kg of calculated weight q12hPHARMACIST CONSULT RECOMMENDED
ONCE DAILY 15 mg/kg of calculated weight q24h
MULTIPLE DAILY 7.5 mg/kg of calculated weight q12h
AVOID aminoglycosides in renal failure patients if possible.
Use 5-7.5 mg/kg of calculated dosing weight after dialysis on dialysis days only.
PHARMACIST CONSULT RECOMMENDED
Dosage varies widely depending on type of renal replacement therapy being used
10 mg/kg of calculated dosing weight as loading dose then 7.5 mg/kg q24-48h
| 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 |
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).
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
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
Increased nephrotoxicity with:
Amphotericin B
Cyclosporine
Cisplatin
NSAIDS
Contrast dye
Vancomycin
Increased ototoxicity with:
Respiratory paralysis with:
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)
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
