Amikacin

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General

  • Type: Aminoglycoside
  • Dosage Forms: injectable solution
  • Routes of Administration: IM, IV
  • Common Trade Names: Amikin

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[1]

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

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014