Amikacin (amikacin sulfate)

Dosage of amikacin sulfate is expressed in terms of amikacin. IM and IV dosage is identical.

Like other aminoglycosides, dosage of amikacin should be individualized taking into consideration the patient's pretreatment body weight, renal status, severity of the infection, and susceptibility of the causative organism. Many clinicians recommend that amikacin dosage be determined using appropriate pharmacokinetic methods for calculating dosage requirements and patient-specific pharmacokinetic parameters (e.g., elimination rate constant, volume of distribution) derived from serum concentration-time data.

Whenever possible, especially in patients with life-threatening infections, suspected toxicity or nonresponse to treatment, decreased or varying renal function, and/or when increased aminoglycoside clearance (e.g., patients with cystic fibrosis, burns) or prolonged therapy is likely, peak and trough serum concentrations of amikacin should be determined periodically and dosage should be adjusted to maintain desired serum concentrations. (See Dosage and Administration: Dosage, in the Aminoglycosides General Statement 8:12.02.) A causal relationship between maintenance of certain peak or trough serum concentrations or other pharmacodynamic endpoints and clinical response or toxicity has not been established to date for amikacin dosing regimens. However, for amikacin administered in conventional dosage regimens (i.e., multiple daily doses), peak serum concentrations of 15-30 and trough concentrations less than 5-10 mcg/mL have been suggested. Amikacin serum concentrations greater than 30-35 mcg/mL may be associated with toxicity. The manufacturers recommend that peak serum concentrations (30-90 minutes after injection) greater than 35 mcg/mL and trough serum concentrations (just prior to the next dose) greater than 10 mcg/mL should be avoided.

Parenteral aminoglycosides historically have been administered in dosage regimens that include multiple daily doses, and current prescribing information for IM or IV amikacin only includes dosage regimens that involve multiple daily doses (usually 2 or 3 doses daily). However, there is evidence that once-daily+ (single-daily) aminoglycoside dosage regimens are at least as effective as, may provide superior pharmacokinetics, and may be less toxic than conventional dosage regimens employing multiple daily doses. Once-daily parenteral aminoglycoside regimens should not be used in all patients. Additional controlled studies in children, patients with renal dysfunction, and other appropriate patient groups are needed to fully define the optimal use of once-daily aminoglycoside dosing regimens. In addition, the most appropriate methods for optimizing dosage selection for once-daily regimens and monitoring serum aminoglycoside concentrations in patients receiving such regimens have not been clearly established. (See Dosage and Administration: Dosage, in the Aminoglycosides General Statement 8:12.02.)

The usual duration of amikacin treatment is 7-10 days. The manufacturers state that safety of amikacin treatment for longer than 14 days has not been established. If a clinical response does not occur within 3-5 days, amikacin should be discontinued and in vitro susceptibility to the drug should be reassessed. In difficult and complicated infections, use of amikacin should be re-evaluated if treatment longer than 10 days is being considered. If the drug is continued, serum amikacin concentrations and renal, auditory, and vestibular functions should be monitored closely.

The maximum dosage of amikacin recommended by the manufacturers is 15 mg/kg (up to 1.5 g) daily.

In patients with impaired renal function, doses and/or frequency of administration of amikacin must be modified in response to serum concentrations of the drug and the degree of renal impairment. There are various methods to determine dosage and a wide variation in dosage recommendations for these patients. However, even when one of these methods is used, peak and trough serum concentrations of the drug should be monitored, especially in patients with changing renal function.

The manufacturers recommend an initial amikacin loading dose of 7.5 mg/kg. For subsequent therapy, the manufacturers state that 7.5-mg/kg doses can be given at intervals (in hours) calculated by multiplying the patient's steady-state serum creatinine (in mg/dL) by 9. Alternatively, many clinicians recommend the dosing method of Sarubbi and Hull, which is based on corrected creatinine clearance. (See Dosage and Administration: Dosage in Renal Impairment, in the Aminoglycosides General Statement 8:12.02.)

In adults with renal failure undergoing hemodialysis, some clinicians recommend supplemental doses of 50-75% of the initial loading dose at the end of each dialysis period. Others suggest that supplemental amikacin doses may not be necessary in patients undergoing short-term hemodialysis. Serum amikacin concentrations should be monitored in dialysis patients and dosage adjusted as needed to maintain desired serum concentrations.

For the treatment of active tuberculosis+ in adults with renal impairment, the ATS, CDC, and IDSA recommend that usual doses be given at less frequent intervals since use of lower doses may reduce efficacy of the drug. These experts recommend that adults with renal impairment receive amikacin in a dosage of 12-15 mg/kg daily given 2 or 3 times weekly. In addition, if the patient is receiving hemodialysis, the dose should be given after the procedure is finished and serum concentrations of the drug monitored to avoid toxicity.

Amikacin sulfate is administered by IM injection or IV infusion.

Amikacin sulfate has been given intrathecally+ or intraventricularly+ as an adjunct to IM or IV administration of the drug for the treatment of meningitis and other CNS infections.

Although amikacin has been given intraperitoneally+, the risk of toxicity associated with this route should be considered. (See Cautions in the Aminoglycosides General Statement 8:12.02.)

Patients should be well hydrated prior to and during amikacin therapy to minimize chemical irritation of renal tubules which may occur as the result of high urine amikacin concentrations.

Renal function should be assessed prior to and daily during amikacin therapy. Patients should be under close clinical observation because of the risk of ototoxicity and nephrotoxicity. (See Cautions in the Aminoglycosides General Statement 8:12.02.)

Prior to administration, amikacin solutions should be inspected visually for particulate matter or discoloration.

No dosing information is available for this tab.

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There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.