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Amikacin Dosage

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Usual Adult Dose for Bacteremia

15 to 22.5 mg/kg/day IV or IM in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)

Usual Adult Dose for Intraabdominal Infection

15 to 22.5 mg/kg/day IV or IM in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)

Usual Adult Dose for Joint Infection

15 to 22.5 mg/kg/day IV or IM in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)

Usual Adult Dose for Osteomyelitis

15 to 22.5 mg/kg/day IV or IM in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)

Usual Adult Dose for Pneumonia

15 to 22.5 mg/kg/day IV or IM in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)

Usual Adult Dose for Skin or Soft Tissue Infection

15 to 22.5 mg/kg/day IV or IM in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)

Usual Adult Dose for Cystic Fibrosis

Higher doses may be required for the treatment of Pseudomonas aeruginosa pulmonary infections in cystic fibrosis patients. Dosing should be individualized and based on serum concentrations. Doses of up to 35 mg/kg/day once daily by IV infusion or in divided doses every 6 to 8 hours have been reported.

Usual Adult Dose for Febrile Neutropenia

Higher doses may be required. Dosing should be individualized and based on serum concentrations. Doses of up to 15 to 30 mg/kg/day IV in 1 to 3 divided doses have been reported in conjunction with a beta-lactam antibiotic (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels).

Usual Adult Dose for Meningitis

IV or IM: 15 to 22.5 mg/kg/day in 1 to 3 divided doses, depending on severity of infection (initial maximum of 1.5 g/day, then adjust dose based on desired serum levels)
Intrathecal: 0.1 mg per mL of CSF or approximately 2 mg/kg body weight per day has been used to treat gram-negative bacillary meningitis in conjunction with parenteral antibiotics

Usual Adult Dose for Nosocomial Pneumonia

20 mg/kg /day IV in 1 to 3 divided doses

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Peritonitis

Peritoneal dialysis-related peritonitis:
CAPD intermittent dosing: 2 mg/kg in 1 exchange/day (based on ideal body weight) intraperitoneally for anuric patients and 2.5 mg/kg/bag for nonanuric patients (investigational)
CAPD continuous dosing: 24 mg/L exchange intraperitoneally for anuric patients and 30 mg/L for nonanuric patients

Maximum dose: 1.5 g/day by all routes

Usual Adult Dose for Tuberculosis - Active

15 mg/kg (maximum 1 g) IM or IV every 24 hours

May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.

Usual Adult Dose for Urinary Tract Infection

Uncomplicated: 250 mg IV or IM every 12 hours
Amikacin is not recommended for mild to moderate infections.

Usual Pediatric Dose for Febrile Neutropenia

1 to 18 years: Higher doses may be required. Dosing should be individualized and based on serum concentrations. Doses ranging from 15 to 30 mg/kg/day in 1 to 3 divided doses have been reported in conjunction with a beta-lactam antibiotic.

Usual Pediatric Dose for Cystic Fibrosis

1 to 18 years: Higher doses and/or more frequent intervals may be required. Dosing should be individualized and based on serum concentrations. Doses of up to 35 mg/kg/day IV in 1 to 3 divided doses have been reported.

Usual Pediatric Dose for Peritonitis

Peritoneal dialysis-related peritonitis:
17 years or less:
Initial dose: 25 mg/L dialysate intraperitoneally
Maintenance dose: 12 mg/L dialysate

Maximum dose: 1.5 g/day by all routes

Usual Pediatric Dose for Tuberculosis - Active

15 to 30 mg/kg (maximum 1 g) IM or IV every 24 hours

May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.

Renal Dose Adjustments

Various nomograms and methods have been proposed for determining the dosage in renally impaired patients - reduced doses at fixed intervals or normal doses at prolonged intervals. As amikacin pharmacokinetics exhibit wide interindividual variability, regimens are ideally based on individualized pharmacokinetic dosing.

Adults:
The following regimen has been proposed for patients with febrile neutropenia:
CrCl 60 to 80 mL/min: 22 mg/kg every 36 hours
CrCl 40 to 60 mL/min: 20 mg/kg every 36 hours
CrCl 20 to 40 mL/min: 20 mg/kg every 48 hours
CrCl 10 to 20 mL/min: 17 mg/kg every 48 hours

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Whenever possible, amikacin levels in serum should be measured to assure adequate but not excessive levels. It is desirable to measure both peak and trough serum levels intermittently during therapy. Peak levels (30 to 90 minutes after injection) above 35 mcg per mL and trough levels (just prior to the next dose) above 10 mcg per mL should be avoided. Dosage should be adjusted as indicated.

In serious infections peak levels of 20 to 25 mcg/mL and trough levels of 1 to 4 mcg/mL have been recommended. In life-threatening infections, peak levels of 25 to 30 mcg/mL and trough levels of 4 to 8 mcg/mL have been recommended.

Precautions

The use of aminoglycosides may result in nephrotoxicity and ototoxicity. The risk is greatest in patients with impaired renal function, those receiving high doses for prolonged periods of time, the elderly, and dehydrated patients. Aminoglycosides have been associated with permanent bilateral auditory and/or vestibular toxicity. Onset of ototoxicity may be delayed and cochlear damage may be asymptomatic, so deafness may not occur until after the drug has been discontinued. Monitoring patients for the development of toxicity is recommended: Serial, vestibular, audiometric, and renal function tests (creatinine clearance, BUN, urinalysis for proteinuria, decreased specific gravity, casts, and cells) should be performed before and during therapy. Patients should be well-hydrated. Patients and their family members should be informed of possible eighth cranial nerve toxicity. Tinnitus may be a sentinel symptom of ototoxicity.

Caution should be used when aminoglycosides are given with other potentially nephrotoxic drugs, such as nonsteroidal anti-inflammatory agents or antineoplastic agents.

Caution should also be used when giving aminoglycosides with other potentially ototoxic drugs, such as loop diuretics. Concomitant use of potent diuretics should be avoided.

The sodium bisulfite preservative in some formulations of amikacin may cause allergic, anaphylactic, or asthmatic reactions in sulfite-sensitive patients.

Aminoglycosides may aggravate muscle weakness due to their potential curare-like effects on neuromuscular function, therefore amikacin should be used cautiously in patients with muscular disorders such as myasthenia gravis or Parkinson's disease.

Dialysis

Adults:
Hemodialysis or peritoneal dialysis patients: 3 to 7.5 mg/kg as a loading dose; calculate subsequent doses based on serum concentrations

Amikacin is dialyzable by hemo- and peritoneal dialysis. A supplemental dose is recommended after dialysis.

Other Comments

The usual duration of treatment is 7 to 10 days. It is desirable to limit the duration of treatment to short term whenever feasible. Uncomplicated infections due to amikacin-sensitive organisms should respond within 24 to 48 hours. If definite clinical response does not occur within 3 to 5 days, therapy should be stopped and the antibiotic susceptibility pattern of the invading organism should be rechecked.

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