amikacin (Amikin)
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Introduction
Tradename: Amikin.
Indications
- adjunct treatment of bacterial infections due to suspeptible organisms, including
- pulmonary tuberculosis, bacterial meningitis, endocarditis, pneumonia
- intra-abdominal infections
- 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
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
Table
| 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
elimination via kidney
1/2life = 2-3 hours adult
1/2life = 0.5-2.5 hours child
1/2life = 2-9 hours neonate
protein binding = <5 %
elimination by hemodialysis = +
elimination by peritoneal dialysis = +/-
Monitor
- peak & trough levels until therapeutic, then weekly thereafter
- monitor creatinine twice a week
- weekly audiometry
Antimicrobial activity
- Enterococcus faecalis (synergy with penicillins)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
- Neisseria gonorrhoeae
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia marcescens
- Proteus vulgaris
- Pseudomonas aeruginosa
- Yersinia enterocolitica
- Campylobacter[6]
Adverse effects
- not common (1-10%)
- ototoxicity
- tinnitus
- vestibular toxicity may occur up to 2-3 months after stopping drug
- nephrotoxicity
- ototoxicity
- uncommon (< 1%)
Laboratory
More general terms
More specific terms
Additional terms
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
- ↑ 6.0 6.1 6.2 Deprecated Reference