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

All aminoglycosides carry potential for cochlear, renal and vestibulotoxicity. If considering using amikacin, strongly consider ID consultation.

For conventional dosing: Target Peak 20-30 mg/L, Trough <4 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 <4 mg/L. Peak levels not recommended.

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

All aminoglycosides carry potential for tubular necrosis and renal failure, deafness due to cochlear toxicity, vertigo due to damage to vestibular organs, and rarely, neuromuscular blockade. If considering using amikacin, strongly consider ID consultation and contact Pharmacy to assist with appropriate dosing.

Perform baseline and ongoing weekly otovestibular toxicity assessment. Formal audiology assessment required if symptoms develop.

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