Amikacin

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 PositiveStrep. Group A, B, C, GR
Strep. PneumoniaeR
Viridans strepX1
Strep. anginosus gpX1
Enterococcus faecalisS
Enterococcus faeciumR
MSSAS
MRSAR
CA-MRSAX1
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesS
Gram NegativesN. gonorrhoeaeR
N. meningitidisR
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+S
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spX1
Serratia marcescensS
Salmonella spX1
Shigella spS
Proteus mirabilisX1
Proteus vulgarisS
Providencia sp.X1
Morganella sp.X1
Citrobacter freundiiX1
Citrobacter diversusX1
Citrobacter sp.X1
Aeromonas spX1
Acinetobacter sp.I
Pseudomonas aeruginosaS
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisS
Brucella sp.S+'
Legionella sp.X1
Pasteurella multocidaX1
Haemophilus ducreyiX1
Vibrio vulnificusI
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spR
Mycobacterium aviumS
AnaerobesActinomycesR
Bacteroides fragilisR
Prevotella melaninogenicaR
Clostridium difficileR
Clostridium (not difficile)X1
Fusobacterium necrophorumR
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
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