*WHAT IS THE

INDICATION OF
BY.EMAN AMIKACIN?
MOHAMED NASR
ELDAKHAKHNY Amikacin has activity against more resistant
gram- negative bacilli such as Acinetobacter

& RADWA baumanii and Pseudomonas aeruginosa. It also

has excellent activity against most aerobic
gram- negative bacilli from the
SALAH Enterobacteriaceae family, including Nocardia

Departement MOHAMED
sp. and some Mycobacterium spp. (M. avium-
intracellulare, M. chelonae, and M. fortuitum).
amikacin does not provide synergistic activity

of clinical ELSHIEKH against Enterococcus faecium when combined

with beta-lactam antibiotics

pharamcy
*DOSING
ADULT:-
Give by IM inj; or IV infusion over 30–60
mins. 15mg/kg per day in 2–3 divided doses

DR.NOHA
(7.5mg/kg every 12 hours or 5mg/kg every 8
hours); max 15mg/kg/day. Heavier wt.
patients: max 1.5g/day. Usual duration: 7–10

ELKHODRY
days. Uncomplicated UTIs: 250mg twice
daily. Renal impairment: adjust dose based
on serum levels or reduce frequency;
CHILDREN:
Infants: give by IM inj; or IV infusion over 1–2
hours. Newborns: loading dose: 10mg/kg;
then follow with 7.5mg/kg every 12 hours.
All other children and older infants: give by

Amikacin
IM inj; or IV infusion over 30–60 mins.
15mg/kg per day in 2–3 divided doses
(7.5mg/kg every 12 hours or 5mg/kg every 8
hours); max 15mg/kg/day. Usual duration: 7–
10 days. Renal impairment: adjust dose
based on serum levels or reduce frequency.
*SIDE EFFECTS
(1-10%)Neurotoxicity- Nephrotoxicity (if trough
>10 mg/L)- Ototoxicity(<1%)
Hypotension-Headache-Drug fever-Rash-
Nausea-Vomiting-Eosinophilia-Paresthesia
Tremor-Arthralgia-Weakness-Allergic reaction
*ADVERSE REACTIONS
Frequency not defined:
Nervous system: Neurotoxicity (including
muscle twitching, numbness, seizure, tingling
of skin)
Otic: Auditory ototoxicity, vestibular ototoxicity
Renal: Nephrotoxicity
Respiratory: Respiratory paralysis
Postmarketing:
Cardiovascular: Hypotension
Dermatologic: Skin rash
Endocrine & metabolic: Albuminuria,
hypomagnesemia
Gastrointestinal: Clostridium difficile-associated
diarrhea, nausea, vomiting
Genitourinary: Azotemia, hematuria, oliguria,
toxic nephrosis
Hematologic & oncologic: Anemia, eosinophilia,
leukocyturia
Hypersensitivity: Drug reaction with
eosinophilia and systemic symptoms (Bensaid
2012)
Nervous system: Drug fever, headache,
paresthesia, tremor
Neuromuscular & skeletal: Arthralgia, state of
neuromuscular blockade (Hashimoto 1978)
Renal: Acute kidney injury, casts in urine,
increased serum creatinine
*CONTRAINDICATIONS
Hypersensitivity to amikacin, other
aminoglycosides, or any component of the
formulation
*WARNING/PRECAUTIONS
• Hypersensitivity: Cross-sensitivity to other
aminoglycosides may occur
• Nephrotoxicity: [US Boxed Warning]: May
cause nephrotoxicity; usual risk factors include
preexisting renal impairment, concomitant
nephrotoxic medications, advanced age and
dehydration. Discontinue treatment if signs of
nephrotoxicity occur; renal damage is usually
reversible.
• Neuromuscular blockade and respiratory
paralysis: [US Boxed Warning]: May cause
neuromuscular blockade and respiratory
paralysis; especially when given soon after
anesthesia or muscle relaxants.
• Neurotoxicity: [US Boxed Warning]: May
cause neurotoxicity; usual risk factors include
preexisting renal impairment, concomitant
neuro-/nephrotoxic medications, advanced age
and dehydration. Ototoxicity is proportional to
the amount of drug given and the duration of
treatment. Tinnitus or vertigo may be
indications of vestibular injury and impending
bilateral irreversible damage. Discontinue
treatment if signs of ototoxicity occur.
• Superinfection: Prolonged use may result in
fungal or bacterial superinfection, including C.
difficile-associated diarrhea (CDAD) and
pseudomembranous colitis; CDAD has been
observed >2 months postantibiotic treatment.
*DRUG INTERACTIONS
Aminoglycosides: Risk X: Avoid combination6
Ataluren: . Risk X: Avoid combination
Bacillus clausii: . Risk D: Consider therapy
modification
Bacitracin (Systemic): . Risk X: Avoid combination
BCG (Intravesical): Risk X: Avoid combination
BCG Vaccine (Immunization):Risk C: Monitor therapy
Bisphosphonate Derivatives:. Risk C: Monitor
therapy
Botulinum Toxin-Containing Products:. Risk C:
Monitor therapy
Cholera Vaccine: Risk X: Avoid combination
CISplatin. Risk X: Avoid combination
Colistimethate: . Risk D: Consider therapy
modification
Distigmine:. Risk C: Monitor therapy
Foscarnet: . Risk X: Avoid combination
Loop Diuretics: . Risk C: Monitor therapy
Mannitol (Systemic): . Risk X: Avoid combination
Mecamylamine: . Risk X: Avoid combination
Methoxyflurane: . Risk X: Avoid combination
Netilmicin (Ophthalmic):. Risk X: Avoid combination
Polymyxin B: Risk X: Avoid combination
Sodium Picosulfate: : Risk D: Consider therapy
modification
Typhoid Vaccine: . Risk D: Consider therapy
modification
Vancomycin: Risk D: Consider therapy modification
*REFERENCES
1.
Endo A, Nemoto A, Hanawa K, Maebayashi Y, Hasebe Y, Kobayashi
M, Naito A, Kobayashi Y, Yamamoto S, Isobe K. Relationship
between amikacin blood concentration and ototoxicity in low birth
weight infants. J Infect Chemother. 2019 Jan;25(1):17-21. []
2.
Nolt VD, Pijut KD, Autry EB, Williams WC, Burgess DS, Burgess DR,
Arora V, Kuhn RJ. Amikacin target achievement in adult cystic
fibrosis patients utilizing Monte Carlo simulation. Pediatr Pulmonol.
2019 Jan;54(1):33-39. []
3.
Kulengowski B, Clark JA, Burgess DS. Killing activity of meropenem
in combination with amikacin against VIM- or KPC-producing
Enterobacteriaceae that are susceptible,
intermediate, or resistant to amikacin. Diagn Microbiol Infect
Dis. 2019 Apr;93(4):372-375. []
4.
Block M, Blanchard DL. StatPearls [Internet]. StatPearls Publishing;
Treasure Island (FL): Jul 19, 2022. Aminoglycosides. []