Amikacin

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

Use actual body weight. In obese patients use dosing body weight (see additional information)Multiple Daily Dose (MDD): Amikacin 5 mg/kg q8h IV

Once Daily (OD) Dose: Amikacin 15 mg/kg q24h IV

Synergy Dosing: Not recommended. Consult Antimicrobial Stewardship for alternative aminoglycoside

For patients with impaired renal function or are obese, consult pharmacy

Please refer to BC Children's Hospital site for neonatal dosing

IV, IM

5 mg/mL

Supplied by Pharmacy

24H Room Temp

0 - 40 eGFR40 - 59 eGFR60+ eGFRAVOID use. If necessary, use conventional aminoglycoside dosing15 mg/kg q36h and consult pharmacy15 mg/kg q24h

0 - 10 eGFR10 - 15 eGFR15 - 35 eGFR36 - 75 eGFR75+ eGFRAvoid5 mg/kg q48h and consult pharmacy5 mg/kg q48-24h and consult pharmacy5 mg/kg IV q18-12h and consult pharmacy5 mg/kg q8h

Infants with HIE or Renal ImpairmentIn infants with impaired renal function and those with moderate to severe HIE receiving induced hypothermia give an initial dose of 7.5 mg/kg x 1 dose then order 2 post dose levels

Consult with NICU pharmacist for timing of levels

General Information

Therapy of gram negative organisms resistant to gentamicin and tobramycin but susceptible to amikacin.

As combination therapy for the treatment of some Mycobacteria spp (i.e. M. abscessus).

Pregnancy: Amikacin crosses the placenta. No reports linking the use of amikacin to congenital defects have been located. Ototoxicity, which is known to occur after amikacin therapy in humans, has not been reported as an effect of in utero exposure. However, other aminoglycosides (streptomycin) have been associated with infant ototoxicity following in utero exposure. If amikacin is required to treat a serious maternal infection, benefit likely outweighs potential risk.

Breastfeeding: Only very small amounts of amikacin are found in breast milk and amikacin is poorly orally absorbed. Likely compatible. Monitor infant for gastrointestinal side effects.

Consult pharmacy for all patients receiving amikacin for level interpretation and dose individualization.

Monitor creatinine at least 2-3 times/week.
Formal audiology assessment should be done if planning to use amikacin for 2 weeks or longer or if any symptoms develop.
Inform patient of risk of otoxocity and to report any symptoms.

Once daily dosing: Pre-dose serum drug levels should be negligible (less than 1 mg/L). Peak levels not required.

Multiple daily dosing: Serum drug levels are recommended around the third dose following initial therapy or any change in dose

  • Pre-dose level: 0 to 30 minutes before next dose should be less than 10 mg/L

  • Post-dose level: 30 minutes after completion of an IV infusion should be 25 to 30 mg/L

  • Nephrotoxicity (non-oliguric) - greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins

  • Vestibulocochlear toxicity (irreversible) - require audiology testing if prolonged use

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

  • Increased nephrotoxicity in combination with other nephrotoxic agents (ie. amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin).

  • Increased ototoxicity: furosemide.

  • Neuromuscular blockade agents - respiratory paralysis.

Consult pharmacy for dosing in obese patients.

In obesity (total body weight (TBW) more than 125% ideal body weight (IBW)), dosing weight is IBW + 0.4 (TBW - IBW).

Antimicrobial class: Aminoglycoside