AMIKACIN

Indications & Dose:

Serious Gram-negative infections resistant to gentamicin (multiple daily dose regimen) 

• BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION 

Adult: 15 mg/kg daily in 2 divided doses, increased to 22.5 mg/kg daily in 3 divided doses for up to 10 days, higher dose to be used in severe infections; maximum 1.5 g per day; maximum 15 g per course Serious Gram-negative infections resistant to gentamicin (once daily dose regimen)

• BY INTRAVENOUS INFUSION 

Adult: Initially 15 mg/kg (max. per dose 1.5 g once daily), dose to be adjusted according to serumamikacin concentration; maximum 15 g per course 

Child

• Severe systemic infections: Same as adult

Neonate

• IV INF 10 mg/kg initially, then 7.5 mg/kg q 12h in diluent over 1-2 hr 

Contraindications:

 Long-termer therapy (ototoxic and nephrotoxic).

Side Effects:

Cautions:

Precautions:

Neonates, renal disease, myasthenia gravis, hearing deficits, Parkinson’s disease, elderly, sulfite sensitivity (contains sodium bisulfite), dehydration 

Interaction:

Drugs

Amphotericin B: Synergistic nephrotoxicity Atracurium: Amikacin potentiates respiratory depression by atracurium

Carbenicillin: Potential for inactivation of amikacin in patients with renal failure

Carboplatin: Additive nephrotoxicity or ototoxicity

Cephalosporins: Increased potential for nephrotoxicity in patients with preexisting renal disease

Cisplatin: Additive nephrotoxicity or ototoxicity

Cyclosporine: Additive nephrotoxicity

Ethacrynic acid: Additive ototoxicity

Indomethacin: Reduced renal clearance of amikacin in premature infants

Methoxyflurane: Additive nephrotoxicity

Neuromuscular blocking agents: Amikacin potentiates respiratory depression by neuromuscular blocking agents

NSAIDs: May reduce renal clearance of amikacin

Penicillins (extended spectrum): Potential for inactivation of amikacin in patients with renal failure

Piperacillin: Potential for inactivation of amikacin in patients with renal failure

Succinylcholine: Amikacin potentiates respiratory depression by succinylcholine

Ticarcillin: Potential for inactivation of amikacin in patients with renal failure

Vancomycin: Additive nephrotoxicity or ototoxicity

Vecuronium: Amikacin potentiates respiratory depression by vecuronium

Warnings:

Adverse Effects:

Lactations:

 Although fetal ototoxicity has occurred after in utero exposure to other aminoglycosides; 8th cranial nerve toxicity has not been reported with amikacin; excreted into breast milk in low concentrations; poor oral bioBrands Available with Cost reduces potential for ototoxicity for the infant 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Confusion, depression, dizziness, muscle twitching, neurotoxicity, numbness, seizures, tremors, vertigo

CV: Hypotension or hypertension, palpitations

EENT: Ototoxicity: hearing loss, deafness; tinnitus, visual disturbances

GI: Nausea, vomiting

GU: Azotemia, hematuria, nephrotoxicity, oliguria, renal failure

HEME: Agranulocytosis, anemia, eosinophilia, leukopenia, thrombocytopenia

SKIN: Alopecia, dermatitis, rash, urticaria 

Patient And Carer Advice: