Amikacin - Renal Dosing

In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.

If worsening renal function, actual GFR is likely lower than calculated.

If improving renal function, actual GFR is likely higher than calculated eGFR.

0 - 40 eGFR

AVOID use. If necessary, use conventional aminoglycoside dosing

40 - 59 eGFR

15 mg/kg q36h and consult pharmacy

60+ eGFR

15 mg/kg q24h

0 - 10 eGFR

Avoid

10 - 15 eGFR

5 mg/kg q48h and consult pharmacy

15 - 35 eGFR

5 mg/kg q48-24h and consult pharmacy

36 - 75 eGFR

5 mg/kg IV q18-12h and consult pharmacy

75+ eGFR

5 mg/kg q8h

Infants with HIE or Renal Impairment

In infants with impaired renal function and those with moderate to severe HIE receiving induced hypothermia give an initial dose of 7.5 mg/kg x 1 dose then order 2 post dose levels

Consult with NICU pharmacist for timing of levels

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