Amikacin - Drug Monitoring

Amikacin - Drug Monitoring

Drug Monitoring

8H dosing or extended intervals for renal impairment (such as Q12H, Q24H etc.)

Trough: 0-30 min before dose. Target: 2.5-10mg/L Peak: 30-60min after end of the infusion. Target: 20-35mg/L

Measure Special Amikacin levels 3 and 6 hours (+/- 30 min) after dose.

  • Target Calculated Cmax: Haematology/Oncology/HPCT = 60-80mg/L
  • Target Calculated Cmax: CF and Mycobacterium infections = 35-45 mg/L

Monitoring Parameters

Urinalysis, urine output, BUN, serum creatinine, peak and trough serum amikacin concentrations; be alert to ototoxicity

With conventional dosing, typically obtain serum concentration after the third dose; exceptions for earlier monitoring may include neonates or patients with rapidly changing renal function. With extended-interval dosing, usually obtain serum concentration after first, second, or third dose

Not all infants and children who receive aminoglycosides require monitoring of serum aminoglycoside concentrations

Indications for use of aminoglycoside serum concentration monitoring include:

  • Treatment course >5 days
  • Patients with decreased or changing renal function
  • Patients with poor therapeutic response
  • Neonates and Infants <3 months of age
  • Atypical body constituency (obesity, expanded extracellular fluid volume)
  • Clinical need for higher doses or shorter intervals (eg, cystic fibrosis, burns, endocarditis, meningitis, critically ill patients, relatively resistant organisms)
  • Patients on hemodialysis or chronic ambulatory peritoneal dialysis
  • Signs of nephrotoxicity or ototoxicity
  • Concomitant use of other nephrotoxic agents