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amikacin (Amikin)
Tradename: Amikin.
Indications:
- adjunct treatment of bacterial infections due to suspeptible organisms, including
- pulmonary tuberculosis, bacterial meningitis, endocarditis, pneumonia
- intra-abdominal infections
- diverticulitis, cholangitis
- urinary tract infections
- skin or soft tissue infections
- infectious arthritis, osteomyelitis
- bacterial infections associated with burns
- bacterial infections in patients with cystic fibrosis
- adjunct empiric treatment of febrile neutropenia
- adjunct empiric treatment of fever of unknown origin [6]
Dosage:
1) 15 mg/kg up to 1500 mg/day IV/IM divided every 8-12 hours
2) 15 mg/kg IV/IM QD
Injection: 50 mg/mL (2 mL); 250 mg/mL (2 & 4 mL)
Therapeutic range: Peak: 20-30 ug/mL. Trough: 5-10 ug/mL
Dosage adjustment in renal failure:
creatinine clearance dosage
> 50-90 mL/min 60-90% every 12 hours
10-50 mL/min* 30-70% every 12-18 hours
< 10 mL/min 20-30% every 24-48 hours
> 80 mL/min 15 mg/kg every 24 hours
60-80 mL/min 12 mg/kg every 24 hours
40-60 mL/min 7.5 mg/kg every 24 hours
30-40 mL/min 4 mg/kg every 24 hours
20-30 mL/min 7.5 mg/kg every 48 hours
10-20 mL/min 4 mg/kg every 48 hours
< 10 mL/min# 3 mg/kg every 48 hours
* same dose for continuous arteriovenous hemofiltration
# 7.5 mg/kg after hemodialysis
Pharmacokinetics:
-> 1/2life
a) 2-3 hours (adult) (17-150 hours ESRD)
b) 0.5-2.5 hours (child)
c) 2-9 hours (neonate)
Antimicrobial activity:
Gram positive
- Enterococcus faecalis (synergy with penicillins)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
Gram negative
- Neisseria gonorrhoeae
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia marcescens
- Proteus vulgaris
- Pseudomonas aeruginosa
- Yersinia enterocolitica
- Campylobacter [6]
Adverse effects:
1) not common (1-10%)
a) ototoxicity
- tinnitus
- vestibular toxicity may occur up to 2-3 months after stopping drug
b) nephrotoxicity
2) uncommon (< 1%)
- hypotension, headache, drowsiness, drug fever, rash, nausea/vomiting, eosinophilia, paresthesia, tremor, arthralgia, weakness
Monitor:
1) peak & trough levels until therapeutic, then weekly thereafter
2) monitor creatinine twice a week
3) weekly audiometry
Laboratory:
- amikacin in body fluid
- amikacin in CSF
- amikacin in serum/plasma
- amikacin free in serum/plasma
- amikacin in serum/plasma peak
- amikacin in serum/plasma trough
- amikacin in serum/plasma post dialysis
Interactions
drug interactions
drug adverse effects of aminoglycosides
Related
amikacin in serum/plasma
Specific
Amikacin Inhalation; amikacin liposome inhalation suspension
General
aminoglycoside antibiotic
Properties
MISC-INFO: elimination route KIDNEY
1/2life 2-3 HOURS
0.5-2.5 HOURS
2-9 HOURS
therapeutic-range 20-30 UG/ML
5-10 UG/ML
toxic-range >40 UG/ML
protein-binding <5%
elimination by hemodialysis +
peritoneal dialysis +/-
pregnancy-category D
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook. Isselbacher et al (eds),
McGraw-Hill Inc. NY, 1995, pg 164
- Sanford Guide to antimicrobial therapy 1997, 2001
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Department of Veterans Affairs, VA National Formulary
- Deprecated Reference