Parenteral Manual

Amikacin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
AMIKIN®
Classification: 
Aminoglycoside antibiotic
Original Date: 
August 2005
Revised Date: 
April 2017
Indications: 
  • Aminoglycoside antibiotic for the treatment of severe gram negative infections caused by susceptible bacteria, that are resistant to gentamicin and tobramycin
Reconstitution and Stability: 
  • Available as a 250 mg/mL solution
  • Stable at room temperature
  • Pale yellow solution does not indicate loss of potency.  Dark coloured solutions should be discarded.
Compatibility: 
  • Solutions Compatible: dextrose solutions up to D20W, 0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate
  • Additives/Above Cassette Compatible: clindamycin
  • Y-site Compatible: morphine, granisetron, potassium chloride, amino acid and dextrose

Incompatible: amphotericin B, azithromycin, heparin, cefazolin, ceftazidime, lipids, Do not mix with beta-lactam antibiotics. Flush line well between administration of  beta-lactams and aminoglycosides

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

 

SC NO
IM YES
Usual dilution: undiluted- 50 mg/mL
IV Direct NO
IV Intermittent Infusion YES
Usual dilution: 10 mg/mL
Infusion time: 30 minutes
IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric: 

  • 15-30 mg/kg/day IM/IV ÷ Q 8 H
  • Maximum: 1.5 g/day

Adolescent/Adult:

  • 15 mg/kg/day IM/IV ÷ Q 8-12 H
  • Maximum:    1.5 g/day

-   Once daily dosing of 15-20 mg/kg/dose over 20-30 minutes has been used in selected patients

Dose interval adjustment in renal impairment with traditional dosing:

  •  CrCl  40 - 60 mL/minute: Administer Q 12 hours
  •  CrCl  20 - 39 mL/minute: Administer Q 24 hours
  •  CrCl  < 20 mL/minute:  Administer normal dose, then monitor levels

    Adjust regimen based on serum concentrations

Potential hazards of parenteral administration: 
  • Hypersensitivity reactions
  • Ototoxicity (dizziness, vertigo, tinnitus, roaring in ears, high frequency hearing loss)
  • Nephrotoxicity
  • Pain on IM injection; localized burning and erythema
  • Transient eosinophilia
  • Thrombophlebitis
  • Other adverse reactions - skin rash, drug fever, nausea, headache, paresthesias
Notes: 
  • Ototoxicity is directly proportional to the amount of drug given and the duration of treatment
  • Adverse effects are potentiated by other ototoxic and nephrotoxic drugs
  • Apnea may result when combined with anesthetics or other neuromuscular blocking drugs
  • Use with caution in patients with impaired renal function (dosage adjustment based on serum levels)
  • Maintain good hydration, baseline serum creatinine and repeat once weekly
  • An audiology consult is recommended for patients who have received IV aminoglycoside therapy for 14 days and for who have received a cumulative of 28 days of therapy in the previous 3 months. Testing should be repeated every 7 days if therapy continues.
  •  Therapeutic Drug Monitoring:
    When checking level, administer next dose as scheduled.  Do not wait for levels to be reported unless otherwise advised

   Therapeutic Serum Concentration: PRE (trough) :  2.5-10 mg/L

                                                     POST (peak) :  20-35 mg/L

   Initial levels on Day 3 and repeat once weekly: PRE: 0-30 minutes prior to next dose
                                                                       POST: 30 minutes after end of infusion

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