HEALTHY LIFESTYLE




Amikacin
Amikacin.JPG

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 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
  • other drugs