Adult: 15 mg/kg daily as a single or in 2 divided doses, by IM inj, IV inj over 2-3 min or IV infusion over 30-60 min. Max: 1.5 g/day. Usual treatment duration: 7-10 days. Child: Neonates: Initial loading dose of 10 mg/kg followed by 7.5 mg/kg 12 hrly. Premature infants: 7.5 mg/kg 12 hrly. 4 wk to 12 yr 15-20 mg/kg as a single or in 2 divided doses. Doses may be given by IM inj, IV inj over 3-5 min or IV infusion over 1-2 hr.
Parenteral Uncomplicated urinary tract infections
Adult: 7.5 mg/kg daily in 2 divided doses by IM inj, slow IV inj over 2-3 min or IV infusion over 30-60 min.
Doses should be adjusted either by administering normal doses at prolonged intervals or by administering reduced doses at fixed intervals based on the patient's CrCl or serum creatinine values.
IV infusion: For adults, add 500 mg of amikacin to 100-200 mL of compatible IV fluid (e.g. NaCl 0.9%, dextrose 5%). For pediatric patients, the vol of diluent depends on the prescribed dosage.
Hypersensitivity to amikacin and other aminoglycosides. Myasthenia gravis.
Patient w/ pre-existing hearing or vestibular damage, muscular disorder (e.g. parkinsonism). Renal impairment. Premature and neonatal infants. Pregnancy and lactation.
Neurotoxicity manifested as vestibular and permanent bilateral auditory ototoxicity, skin rash, drug fever, headache, paraesthesia, tremor, nausea and vomiting, eosinophilia, arthralgia, anaemia, hypotension, hypomagnesaemia; macular infarction following intravitreous admin. Potentially Fatal: Nephrotoxicity, neuromuscular blockade and resp paralysis, Clostridium difficile-associated colitis.
May cause adverse reactions which may impair ability to drive or operate machinery.
Monitor renal function, appropriately timed peak and trough concentrations, vital signs, temperature, wt, input and output, hearing parameters.
Symptoms: Nephrotoxicity, ototoxicity, neuromuscular blockade and resp arrest. Management: May perform peritoneal dialysis, haemodialysis or arteriovenous haemofiltration to reduce amikacin serum levels. In newborn infants, exchange transfusion may be considered. Neuromuscular blockade and resp arrest may be treated by application of ionic Ca (e.g. as gluconate or lactobionat in 10-20% soln).
Additive effect w/ other neurotoxic, ototoxic or nephrotoxic agents (e.g. bacitracin, cisplatin, amphotericin B, ciclosporin, tacrolimus, cefaloridine, paromomycin, viomycin, polymyxin B, colistin, vancomycin, and other aminoglycosides). Enhanced toxicity w/ rapidly acting diuretics (e.g. furosemide, ethacrynic acid). Increased creatinine serum level w/ cephalosporins. Indomethacin may increase the plasma concentration of amikacin in neonates. Increased risk of hypocalcaemia w/ biphosphonates. Increased risk of nephrotoxicity and possibly ototoxicity w/ platinum compounds. Increased risk of neuromuscular blockade and consequent resp depression w/ anaesth or muscle relaxants (e.g. ether, halothane, d-tubocurarine, succinylcholine decamethonium, atracurium, rocuronium, vecuronium).
Description: Amikacin is an aminoglycoside antibiotic which is active against a broad spectrum of gm-ve organisms. It inhibits protein synthesis in susceptible bacteria by binding to 30S ribosomal subunits. Pharmacokinetics: Absorption: Rapidly absorbed (IM). Time to peak plasma concentration: 1 hr (IM); over 30 min (IV). Distribution: Detected in body tissues and fluids. Crosses the placenta but does not readily penetrate into CSF, substantial penetration of the blood-brain barrier was reported in childn w/ meningitis. Volume of distribution: 0.25 L/kg. Plasma protein binding: ≤11%. Excretion: Via glomerular filtration in the urine (94-98%). Plasma half-life: Approx 2-3 hr.
Amikacin Sulfate Injection, Solution (Teva Parenteral Medicines, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/10/2014.Anon. Amikacin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/10/2014.Buckingham R (ed). Amikacin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/10/2014.McEvoy GK, Snow EK, Miller J et al (eds). Amikacin Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 15/10/2014.