Antibacterial agent

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

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

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

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

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

IM/IV

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)

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

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