Amikacin

General Toxicity Notes
Nephrotoxic, ototoxic. Toxicity worse when hyperbilirubinemic. Measure serum levels for efficacy and toxicity. Peritoneal absorption increases with presence of inflammation. Vd increases with edema, obesity, and ascites. Do not use once-daily dosing in patients with CrCl <30-40 mL/min or in patients with acute renal failure or uncertain level of kidney function.
Excreted Unchanged %
95
Half-Life (Normalesrd) Hours
1.4-2.3/17-150
Plasma Protein Binding %
<5
Volume Of Distribution L/Kg
0.22-0.29
Dose For Normal Renal Function
7.5 mg/kg q12h or 15 mg/kg qd
Adjustment For Renal Failure Method
I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% q12 or 24h [B]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% q24-72h by levels [B]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
100% q48-72h by levels [B]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: full dose after dialysis
Supplement For Dialysis [Recommendation Level]: Pd
PD: 15-20 mg/L/d
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, monitor levels, [B]
References
French MA, Cerra FB, Plaut ME, Schentag JJ. Amikacin and gentamicin accumulation pharmacokinetics and nephrotoxicity in critically ill patients. Antimicrob Agents Chemother. 1981; 19: 147-52. [PMID: 7247354] / Kihara M, Ikeda Y, Takagi N, Fujita H, Shibata K, Masumori S, et al. Pharmaco-kinetics of single-dose intravenous amikacin in critically ill patients undergoing slow hemodialysis. Intensive Care Med. 1995; 21: 348-51. [PMID: 7650258] / Kinowski JM, de la Coussaye JE, Bressolle F, Fabre D, Saissi G, Bouvet O, et al. Multiple-dose pharmacokinetics of amikacin and ceftazidime in critically ill patients with septic multiple-organ failure during intermittent hemofiltration. Antimicrob Agents Chemother. 1993; 37: 464-73. [PMID: 8460915] / Regeur L, Colding H, Jensen H, Kampmann JP. Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis. Antimicrob Agents Chemother. 1977; 11: 214-8.[PMID: 848923]
Toxicity Notes
Monitor levels.