Amikacin
Mechanism :
Semi-synthetic aminoglycoside. Inhibits protein synthesis in susceptible bacteria by binding to ribosomal subunits.
Indication :
- Amikacin is usually effective against Pseudomonas, Klebsiella, Enterobacter, Serratia, Proteus, and E. coli; documented infection of mycobacterial organisms susceptible to amikacin.
Contraindications :
A history of hypersensitivity to amikacin is a contraindication for its use.
Dosing :
Adjust dose according to serum levels.
Neonates ≤7 days:
≤29 weeks of gestational age: 18 mg/kg IV/IM every 48 hours.
30-33 weeks gestational age: 18 mg/kg IV/IM every 36 hours.
≥34 weeks gestational age: 15 mg/kg IV/IM every 24 hours.
Neonates >7 days:
>30-33 weeks of gestational age: 15 mg/kg IV/IM every 24 hours.
Neonates 8-28 days and <29 weeks gestational age: 15 mg/kg IV/IM every 36 hours.
Neonates aged >28 days old and >29 weeks gestational age: 15 mg/kg IV/IM every 24 hours.
Infants and children: 15 mg/kg IV/IM every 24 hours.
Adverse Effect :
Ototoxicity, nephrotoxicity, neuromuscular blockade, fever, headache, dizziness, drowsiness, ataxia, vertigo, rash, nausea, vomiting, eosinophilia, anemia, leukopenia.
Interaction :
Vancomycin, Cephalosporin, Cyclosporine, Furosemide, Cisplatin, Amphotericin: Increases chances of ototoxicity and nephrotoxicity
Non-depolarising muscle relaxants: Enhances effect.
Neostigmine, Pyridostigmine: Antagonises effect.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | 5–6 mg/kg every 12 hours |
| 10-20 | 3–4 mg/kg every 24 hours |
| <10 | 2 mg/kg every 24–48 hours |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<10 mL/ min |
| HD | Dialysed. Give 5 mg/kg after dialysis. |
| HDF/High flux | Dialysed. Give 5 mg/kg after dialysis. |
| CAV/VVHD | Dialysed. 7.5 mg/kg every 24 hours and monitor levels |
Hepatic Dose :
No dosage adjustments are recommended. Use with caution in liver disease due to risk of hepato-renal syndrome.