Antimicrobials
Amikacin

Amikacin

Low
N/A
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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).

Monitoring serum levels:

Traditional dosing:

  • Serum levels pre-dose (trough): taken 5 minutes before next dose; should be between 5-8mg/L
  • Serum levels post-dose (peak): taken 30 minutes after the end of IV infusion or 60 minutes after IM injection; should be between 20-30mg/L

Extended interval dosing:

  • Serum levels pre-dose (trough): taken 5 minutes before next dose; should be undetectable (i.e. less than 2.5 mg/L)
  • Serum levels post-dose (peak): no need to monitor

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

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.

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