Antimicrobials
Amikacin

Amikacin

C difficile risk
Low
Oral Bioavailability
N/A
Cost
$162.00/day

Dosing

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.

No adjustment required

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

General Information

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

  •  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

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