Infectious Disease Compendium

Amikacin (Amikin®)

Dosing

CrCl Formula

What follows is the old fashioned way to dose amikacin, useful for endocarditis. For once a day dosing and rational click here.

CrCl > 80: 15 mg/kg q 8 - 12 h.

CrCl 80-50: q 8 - 12 h iv.

CrCl 50-10: q 12 - 48 h iv.

CrCl < 10: q 48 h or more.

Hemodialysis: 2.5 mg/kg after hemodialysis.

Peritoneal dialysis: 2.5 mg /kg/day.

Important side effects

Eighth nerve and renal toxicity.

Important drug interactions

Increased nepho and ototoxicty with other oto and nephrotoxic agents.

Can worsen muscular disorders such as myasthenia gravis or Parkinson's disease.

Rants and Screeds

As with all the aminoglycosides, the classic peak and trough (peak 15-40 mg/L, trough 5-10 mg/L) are meaningless. Want to get a maximal peak and a non measurable trough for maximal therapy/minimal toxicity.

Pearls

By the way, aminoglycosides should probably be used as monotherapy only for urinary tract infections (PubMed).

Treatment of choice

Don't use for

Here for the skinny on aminoglycosides.

Use for

Gram-negative aerobes.

TB and some NMTB. Nocardia.

A liposome inhalation suspension for Mycobacterium avium complex, cystic fibrosis and bronchiectasis (PubMed). 590 mg/8.4 mL inhaled daily at a cost, as of 4/2019, of $140,000 a year.

Class

Aminoglycoside.

Last update: 04/04/2019