Antimicrobials
Amikacin

Amikacin

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Low
N/A
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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 spp (i.e. M. abscessus).

Laboratory

  • Monitor creatinine. Discontinue if any signs of nephro- or ototoxicity

Clinical

  • Baseline and periodic hearing and vestibular function (questioning audiologic testing with prolonged therapy)
  • Formal audiology assessment if planning to use aminoglycoside for >7 days or if symptoms develop.
  • Inform patient of risk of potentially irreversible ototoxicity and to report any symptoms since this can be difficult to identify
  • Nephrotoxicity
  • Auditory toxicity
  • Vestibular toxicity
  • Neuromuscular blockade (especially with myasthenia or Parkinson’s disease and rapid infusion of large aminoglycoside doses)

Increased nephrotoxicity with: amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin.

Increased ototoxicity when given concomitantly with loop diuretics. 

Penicillins: in vitro inactivation. Do not mix or run in the same tubing.

Neuromuscular blockade agents: respiratory paralysis.

Antimicrobial class: Aminoglycoside

Pregnancy category: D - risk of eighth cranial nerve toxicity in fetus is well documented with other aminoglycosides and could potentially occur with amikacin

Breastfeeding: Compatible with breastfeeding. Only a trace amount of amikacin was found in some nursing infants. Due to the poor absorption of aminoglycoside, the systemic toxicity should not occur, but an alteration in normal bowel flora may occur in nursing infants.

Average serum half life: 2.5 hours

Distribution: Hydrophilic; 0.2-0.4 L/kg (may be higher in pregnancy, ascites, edema, sepsis, and burn pts); distributed in extracellular fluid, abscesses, ascites fluid, pericardial fluid, pleural fluid, synovial fluid, lymphatic fluid and peritoneal fluid. Poor distribution into bile, aqueous humor, bronchial secretions, abscess, sputum, and CSF.

Biliary penetration: Moderate

CSF penetration: Poor

Urine penetration: Therapeutic

Adapted from the UCLA Health Antimicrobial Stewardship Program