Amikacin

General

• Type: Aminoglycoside
• Dosage Forms: IM, IV
• Common Trade Names:

Adult Dosing

• Bacterial infections
  • 7.5mg/kg IM/IV q12h OR
  • 5mg/kg IM/IV q8h
• Uncomplicated UTI
  • 250mg IM BID

Pediatric Dosing

• Neonates:
  • 10mg/kg IM/IV x 1 THEN
  • 7.5mg/kg IM/IV q12h
• Infants / Children
  • 5mg/kg IM/IV q8h MAX 1.5 g/day

Special Populations

• Pregnancy Rating: D
• Lactation: Safety Unknown
• Renal Dosing
  • Adult
    • CrCl 50-80 give q12-24h
    • CrCl 10-50 give q24-48h
    • CrCl <10 give q48-72h
    • HD: give supplement
  • Pediatric
    • CrCl 30-50 give q12-18h
    • CrCl 10-29 give q18-24h
    • CrCl <10 give q48-72h
    • HD/PD start 5mg/kg x 1, no supplement
• Hepatic Dosing Not Defined

Contraindications

• Allergy to class/drug

Caution if:

• hypersensitive to sulfites
• renal impairment
• dehydration
• concurrent nephrotoxic agent use
• impaired auditory/vestibular function
• concurrent ototoxic/neurotoxic agent use
• neuromuscular disease
• electrolyte abnormalities

Adverse Reactions

Serious

• Nephrotoxicity
• Ototoxicity
• Neurotoxicity
• Neuromuscular blockade
• Superinfection

Common

• Elev. BUN / Cr
• Hearing loss / tinnitus
• Vertigo
• Injection site reaction

Pharmacology

• Half-life: 2h (30-86 h in renal impairment)
• Metabolism: None
• Excretion: Urine
• Mechanism of Action: Bactericidal, binds to 30S ribosomal subunit, inhibits protein synthesis.

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	R
	Strep. Pneumoniae	R
	Viridans strep	X1
	Strep. anginosus gp	X1
	Enterococcus faecalis	S
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	X1
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	R
	N. meningitidis	R
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	X1
	Serratia marcescens	S
	Salmonella sp	X1
	Shigella sp	S
	Proteus mirabilis	X1
	Proteus vulgaris	S
	Providencia sp.	X1
	Morganella sp.	X1
	Citrobacter freundii	X1
	Citrobacter diversus	X1
	Citrobacter sp.	X1
	Aeromonas sp	X1
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	S
	Brucella sp.	S+'
	Legionella sp.	X1
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	I
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	S
Anaerobes	Actinomyces	R
	Bacteroides fragilis	R
	Prevotella melaninogenica	R
	Clostridium difficile	R
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	R
	Peptostreptococcus sp.	R

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

References

Authors

Ross Donaldson, Ben Isakson, Neil Young, Daniel Ostermayer, Claire