Adult Dosing
Bacterial infections
- 15 mg/kg/day IM/IV divided q8-12 hrs
- Max: 1.5 g/day
Uncomplicated urinary tract infections
- 250 mg IM/IV bid
- Note: Usual duration of treatment is 7-10 days
Pediatric Dosing
Serious infections caused by susceptible organisms
- Neonates: Initially, 10 mg/kg IM/IV, then 7.5 mg/kg q12 hrs
- Infants/Children: 5 mg/kg IM/IV q8 hrs; Max: 1.5 g/day
[Outline]
Renal Dose Adjustment (Based on CrCl)
Normal dosage at prolonged intervals
- Loading dose: 7.5 mg/kg IM/IV
- Maintenance dose: 7.5 mg/kg per calculated interval, SrCr (mg/100 mL) × 9 = interval (hours)
Reduced dosage at fixed intervals
- Measure serum amikacin concentrations to assure accurate administration of amikacin and to avoid concentrations above 35 mcg/mL
- Loading dose: 7.5 mg/kg IM/IV
- Maintenance dose: [Observed CrCl in mL/min/Normal CrCl in mL/min] x calculated loading dose in mg (administer maintenance dose q 12 hrs)
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Amikacin causes nephrotoxicity and neurotoxicity, risk factors include concomitant neurotoxic and/or nephrotoxic agents, diuretics, advancing age, and dehydration [U.S Black Box Warning]
- Neuromuscular blockade leading to irreversible deafness, renal failure, and death due to respiratory paralysis reported after administration by topical application
- Obtain culture and susceptibility tests before starting therapy; use only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
- Significant potential for nephrotoxicity. Patients should be well-hydrated to minimize chemical irritation of the renal tubules
- Aminoglycosides can cause fetal harm when administered to a pregnant woman
- Risk of sensitivity to sulfites, may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible individuals
- Peak concentrations (30-90 minutes after injection) > 35 mcg/mL and trough concentrations (just prior to the next dose) > 35 mcg/mL should be avoided
- Superinfection may occur, initiate appropriate therapy
- Cross-sensitivity among aminoglycosides may occur
- Monitor BUN/Cr at baseline, then periodically
- Monitor serum drug levels; urinalysis
- Perform audiometry for high risk pts, planned prolonged therapy, if high serum levels or signs of hearing impairment
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Auditory impairment
- Impaired vestibular function
- High dose therapy
- Prolonged treatment
- Electrolytes abnormalities
- Concurrent ototoxic agents
- Concurrent nephrotoxic agents
- Concurrent neurotoxic agents
- Neuromuscular disease
- Electrolyte abnormalities
- Dehydration
- Neonates/infants
- Geriatric population
Pregnancy Category:D
Breastfeeding: Amikacin is poorly excreted in breastmilk. Monitor the infant for possible effects on the GI flora, such as diarrhea, candidiasis or rarely, blood in the stool indicating possible antibiotic-associated colitis. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 2 July 2010)
