AMIKACIN SULFATE

AMIKACIN SULFATE
(am-i-kay'sin)
Amikin
Classifications: aminoglycoside antibiotic;
Therapeutic: antibiotic

Prototype: Gentamicin
Pregnancy Category: C

Availability

250 mg/mL, 50 mg/mL injection

Action

Appears to inhibit protein synthesis in bacterial cells and is usually bactericidal.

Therapeutic Effect

Effective against a wide range of gram-negative bacteria, including many strains resistant to other aminoglycosides. Also effective against penicillinase- and non-penicillinase-producing Staphylococcus.

Uses

Primarily for short-term treatment of serious infections of respiratory tract, bones, joints, skin, and soft tissue, CNS (including meningitis), peritonitis burns, recurrent urinary tract infections (UTIs).

Unlabeled Uses

Intrathecal or intraventricular administration, in conjunction with IM or IV dosage.

Contraindications

History of hypersensitivity or toxic reaction with an aminoglycoside antibiotic; pregnancy (category C); lactation.

Cautious Use

Impaired renal function; eighth cranial (auditory) nerve impairment; preexisting vertigo or dizziness, tinnitus, or dehydration; fever; older adults, premature infants, neonates and infants; myasthenia gravis; parkinsonism; hypocalcemia.

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 5–7.5 mg/kg loading dose, then 7.5 mg/kg q12h (max: 15 mg/kg/d) for 7–10 d
Child: IV/IM 5–7.5 mg/kg loading dose, then 5 mg/kg q8h or 7.5 mg/kg q12h for 7–10 d (max: 1.5 g/d)
Neonate: IV/IM 10 mg/kg loading dose, then 7.5 mg/kg q12h for 7–10 d

Uncomplicated UTI
Adult: IV/IM 250 mg q12h

Obesity
Calculate dose based on IBW.

Renal Impairment
Clcr over 60 mL/min: normal dose q8h; 40–60 mL/min: normal dose
q12h; 20–39 mL/min: half dose q24h; <20 mL/min: administer loading dose then monitor closely
Dialysis: Administer dose post-dialysis or give 2/3 dose as supplemental dose

Administration

Intramuscular
  • Use the 250 mg/mL vials for IM injection. Calculate the required dose and withdraw the equivalent number of mLs from the vial.
  • Give deep IM into a large muscle.
Intravenous
  • Verify correct IV concentration and rate of infusion with physician for neonates, infants, and children.

PREPARE: Intermittent: ??Add contents of 500 mg vial to 100 or 200 mL D5W, NS injection, or other diluent recommended by manufacturer.??For pediatric patients, volume of diluent depends on patient's fluid tolerance.?? Note: Color of solution may vary from colorless to light straw color or very pale yellow. Discard solutions that appear discolored or that contain particulate matter.  

ADMINISTER: Intermittent: ??Give a single adult dose (including loading dose) over at least 30–60 min by IV infusion.??Increase infusion time to 1–2 h for infants.??Monitor infusion rate carefully. A rapid rise in serum amikacin level can cause respiratory depression (neuromuscular blockade) and other signs of toxicity. 

INCOMPATIBILITIES Solution/additive: Aminophylline, amphotericin B, ampicillin, cephalosporins, chlorothiazide, heparin, penicillins, phenytoin, thiopental, vitamin B complex with C. Y-site: Allopurinol, amphotericin B, azithromycin, hetastarch, propofol, thiopental.

  • Store at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

CNS: Neurotoxicity: drowsiness, unsteady gait, weakness, clumsiness, paresthesias, tremors, convulsions, peripheral neuritis. Special Senses: Auditory–ototoxicity, high-frequency hearing loss, complete hearing loss (occasionally permanent); tinnitus; ringing or buzzing in ears; Vestibular: dizziness, ataxia. GI: Nausea, vomiting, hepatotoxicity. Metabolic: Hypokalemia, hypomagnesemia. Skin: Skin rash, urticaria, pruritus, redness. Urogenital: Oliguria, urinary frequency, hematuria, tubular necrosis, azotemia. Other: Superinfections.

Interactions

Drug: anesthetics, skeletal muscle relaxants have additive neuromuscular blocking effects; acyclovir, amphotericin B, bacitracin, capreomycin, cephalosporins, colistin, cisplatin, carboplatin, methoxyflurane, polymyxin B, vancomycin, furosemide, ethacrynic acid increase risk of ototoxicity and nephrotoxicity.

Pharmacokinetics

Peak: 30 min IV; 45 min to 2 h IM. Distribution: Does not cross blood–brain barrier; crosses placenta; accumulates in renal cortex. Elimination: 94–98% renally in 24 h, remainder in 10–30 d. Half-Life: 2–3 h in adults, 4–8 h in neonates.

Nursing Implications

Assessment & Drug Effects

  • Baseline tests: Before initial dose, C&S; renal function and vestibulocochlear nerve function (and at regular intervals during therapy; closely monitor in the older adult, patients with documented ear problems, renal impairment, or during high dose or prolonged therapy).
  • Monitor peak and trough amikacin blood levels: Draw blood 1 h after IM or immediately after completion of IV infusion; draw trough levels immediately before the next IM or IV dose.
  • Lab tests: Periodic serum creatinine and BUN, complete urinalysis. With treatment over 10 d, daily tests of renal function, weekly audiograms, and vestibular tests are strongly advised.
  • Monitor serum creatinine or creatinine clearance (generally preferred) more often, in the presence of impaired renal function, in neonates, and in the older adult; note that prolonged high trough (>8 mcg/mL) or peak (>30–35 mcg/mL) levels are associated with toxicity.
  • Monitor S&S of ototoxicity [primarily involves the cochlear (auditory) branch; high-frequency deafness usually appears first and can be detected only by audiometer]; indicators of declining renal function; respiratory tract infections and other symptoms indicative of superinfections and notify physician should they occur.
  • Monitor for and report auditory symptoms (tinnitus, roaring noises, sensation of fullness in ears, hearing loss) and vestibular disturbances (dizziness or vertigo, nystagmus, ataxia).
  • Monitor & report any changes in I&O, oliguria, hematuria, or cloudy urine. Keeping patient well hydrated reduces risk of nephrotoxicity; consult physician regarding optimum fluid intake.

Patient & Family Education

  • Report immediately any changes in hearing or unexplained ringing/roaring noises or dizziness, and problems with balance or coordination.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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