Amikacin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

15 mg/kg/day in 2 divided doses (maximum
dose: 1.5 g/day; maximum cumulative dose:
15 g)

PHARMACOKINETICS

  • Molecular weight                           :
    585.6
  • %Protein binding                           :
    <20
  • %Excreted unchanged in urine     :
    94–98
  • Volume of distribution (L/kg)       :
    0.22–0.29
  • half-life – normal/ESRD (hrs)      :
    2–3/17–150

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : 5–6 mg/kg every 12 hours
  • 10 to 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 levels1

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Botulinum toxin: neuromuscular blockenhanced – risk of toxicity
  • Ciclosporin: increased risk ofnephrotoxicity
  • Cytotoxics: increased risk with platinumcompounds of nephrotoxicity and possibly
    of ototoxicity
  • Diuretics: increased risk of ototoxicitywith loop diuretics
  • Muscle relaxants: enhanced effects ofnon-depolarising muscle relaxants and
    suxamethonium
  • Parasympathomimetics: antagonism ofeffect of neostigmine and pyridostigmine
  • Tacrolimus: increased risk ofnephrotoxicity

    ADMINISTRATION

    Reconstition

    Route

    IM/IV

    Rate of Administration

    IV bolus – slow over 2–3 minutes

    Infusion – at concentration 2.5 mg/mL

    over 30 minutes
    (Diluents: sodium chloride 0.9%, glucose

    5% and others)

    Comments

  • May be used intraperitoneally
  • Can be given in 50 mL. (UK Critical CareGroup, Minimum Infusion Volumes for
    fluid restricted critically ill patients, 3rd
    Edition, 2006.)
  • Do not mix physically with any otherantibacterial agents

    OTHER INFORMATION

  • Nephrotoxic and ototoxic; toxicity noworse when hyperbilirubinaemic
    Serum levels must be measured for

    efficacy and toxicity

  • Peritoneal absorption increases in thepresence of inflammation
  • Volume of distribution increases withoedema, obesity and ascites
  • Peak serum concentration should notexceed 30 mg/L
  • Trough serum concentration should beless than 5 mg/L
  • Amikacin affects auditory function to agreater extent than gentamicin
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