Classifications: aminoglycoside antibiotic; Therapeutic: antibiotic
Pregnancy Category: C
250 mg/mL, 50 mg/mL injection
Appears to inhibit protein synthesis in bacterial cells and is usually bactericidal.
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.
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).
Intrathecal or intraventricular administration, in conjunction with IM or IV dosage.
History of hypersensitivity or toxic reaction with an aminoglycoside antibiotic; pregnancy (category C); lactation.
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 57.5 mg/kg loading dose, then 7.5 mg/kg q12h (max: 15 mg/kg/d) for 710 d
Child: IV/IM 57.5 mg/kg loading dose, then 5 mg/kg q8h or 7.5 mg/kg q12h for 710 d (max: 1.5 g/d)
Neonate: IV/IM 10 mg/kg loading dose, then 7.5 mg/kg q12h for 710 d
Adult: IV/IM 250 mg q12h
Calculate dose based on IBW.
Clcr over 60 mL/min: normal dose q8h; 4060 mL/min: normal dose
q12h; 2039 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
- Use the 250 mg/mL vials for IM injection. Calculate the required dose and withdraw the equivalent number of mLs from the
- Give deep IM into a large muscle.
- 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 3060 min by IV infusion.??Increase infusion time to 12 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: Auditoryototoxicity,
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,
, 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.
30 min IV; 45 min to 2 h IM. Distribution:
Does not cross bloodbrain barrier; crosses placenta; accumulates in renal
9498% renally in 24 h, remainder in 1030 d. Half-Life:
23 h in adults, 48 h in neonates.
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 (>3035 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