Spectrum of Activity


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, avium complex).

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

For multiple daily dosing: Target Peak Disease Specific

  • UTI: 15-20 mcg/mL
  • Soft tissue, pyelonephritis, sepsis: 20-25 mcg/mL
  • Pneumonia: 25-30 mcg/mL
  • Target trough < 8 mcg/mL

For extended interval dosing:

  • Target trough < 4 mcg/mL
  • Target peak 10 mg/kg: 20-30 mcg/mL
  • Target peak 15 mg/kg: 40-50 mcg/mL
  • Target peak 20 mg/kg: 40-60 mcg/mL

Nephrotoxicity (non-oliguric)

  • Less common with extended interval dosing.
  • Avoid concomitant nephrotoxins.
  • Greater toxicity with longer duration and supratherapeutic trough levels.

Vestibulocochlear toxicity

  • Possibly irreversible
  • Audiology testing required for prolonged use


  • Can exacerbate neuromuscular blockade - e.g. contraindicated in patients with myasthenia gravis.

Increased nephrotoxicity with:

  • Amphotericin B

  • Cyclosporine

  • Cisplatin


  • Contrast dye

  • Vancomycin

Increased ototoxicity with:

  • Furosemide

Respiratory paralysis with:

  • Neuromuscular blockade agents
  • Formal audiology assessment required if planning to use aminoglycoside for >7d or if symptoms develop
  • Inform patient of risk of ototoxicity and to report any symptoms
  • Cost per day for the average adult dose (70kg) of 1g IV q24h

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2 hours

Urine penetration: Therapeutic

Lung penetration: Low (if using IV)

CSF penetration: Poor

Biliary penetration: Moderate