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 &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
    585.6
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
    <20
  • %Excreted unchanged in urine &nbsp &nbsp :
    94–98

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :
    0.22–0.29

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :
    2–3/17–150

    DOSE IN RENAL IMPAIRMENT


    GFR (mL/MIN)


  • 20 to 50 &nbsp &nbsp : 5–6 mg/kg every 12 hours
  • 10 to 20 &nbsp &nbsp : 3–4 mg/kg every 24 hours
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp :
    2 mg/kg every 24–48 hours

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES


  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:
    Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/
    min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
    Dialysed. Give 5 mg/kg after
    dialysis.
  • HDF/high flux &nbsp :
    Dialysed. Give 5 mg/kg after
    dialysis.
  • CAV/VVHD &nbsp &nbsp &nbsp:
    Dialysed. 7.5 mg/kg every
    24 hours and monitor levels1

    IMPORTANT DRUG INTERACTIONS


    Potentially hazardous interactions with other drugs

  • Botulinum toxin: neuromuscular block

    enhanced – risk of toxicity

  • Ciclosporin: increased risk of

    nephrotoxicity

  • Cytotoxics: increased risk with platinum

    compounds of nephrotoxicity and possibly
    of ototoxicity

  • Diuretics: increased risk of ototoxicity

    with loop diuretics

  • Muscle relaxants: enhanced effects of

    non-depolarising muscle relaxants and
    suxamethonium

  • Parasympathomimetics: antagonism of

    effect of neostigmine and pyridostigmine

  • Tacrolimus: increased risk of

    nephrotoxicity

    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 Care

    Group, Minimum Infusion Volumes for
    fluid restricted critically ill patients, 3rd
    Edition, 2006.)

  • Do not mix physically with any other

    antibacterial agents

    OTHER INFORMATION

  • Nephrotoxic and ototoxic; toxicity no

    worse when hyperbilirubinaemic
    Serum levels must be measured for

    efficacy and toxicity

  • Peritoneal absorption increases in the

    presence of inflammation

  • Volume of distribution increases with

    oedema, obesity and ascites

  • Peak serum concentration should not

    exceed 30 mg/L

  • Trough serum concentration should be

    less than 5 mg/L

  • Amikacin affects auditory function to a

    greater extent than gentamicin

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