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항생제
Amikacin

Amikacin

Low
N/A

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).

Black Box Warning:

  • Patients with impaired renal function, advanced age, dehydration, and those who receive high dosage or prolonged therapy are at an increased risk of toxicity.
  • Monitor renal and auditory function during therapy and discontinue therapy or adjust dose if there is evidence of ototoxicity or nephrotoxicity.
  • Aminoglycoside-induced ototoxicity is usually irreversible. Serum concentrations of aminoglycosides should be monitored when feasible to assure adequate levels and to avoid potentially toxic levels.
  • Neuromuscular blockade and respiratory paralysis have also been reported following administration.
  • Concurrent use of other potentially neurotoxic agents, nephrotoxic agents, or potent diuretics should be avoided.

Monitor creatinine at least 3 times/week; discontinue if any signs of ototoxicity.

For BID dosing: Target Peak 15-30 mg/L, Trough <5 mg/L. Peak levels usually not required but if drawn, record time of dose and time of level drawn as accurately as possible.

Consult pharmacist for level interpretation and dose individualization.

For once daily dosing: Target Trough <1 mg/L. Peak levels not recommended.

Serious

  • Neuromuscular blockade finding - contraindicated in patients with myasthenia gravis
  • Ototoxicity
  • Nephrotoxicity
  • Respiratory tract paralysis

Increased nephrotoxicity with:

  • Amphotericin B
  • Cyclosporine
  • Cisplatin
  • NSAIDS
  • Contrast dye
  • Vancomycin

Increased ototoxicity with:

  • Furosemide

Respiratory paralysis with:

  • Neuromuscular blockade agents

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

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.