What is the dosing and usage of Amikacin (amikacin) with Merrem (meropenem) and Vancomycin (vancomycin) for severe infections?

From the Guidelines

For severe infections requiring triple antibiotic therapy with amikacin, meropenem, and vancomycin, the typical adult dosing regimen is as follows. Amikacin is usually administered at 15-20 mg/kg once daily (typically 1-1.5 g/day), with dose adjustments needed for renal impairment, as suggested by 1. Therapeutic drug monitoring is essential, aiming for peak levels of 20-35 mcg/mL and trough levels below 5-10 mcg/mL to prevent nephrotoxicity and ototoxicity. Meropenem is typically given at 1-2 g every 8 hours intravenously, with dose reductions for renal impairment, as indicated by 1. Vancomycin dosing is weight-based at 15-20 mg/kg every 8-12 hours (not exceeding 2 g per dose), with target trough levels of 15-20 mcg/mL for severe infections, as recommended by 1. All three medications require renal function monitoring, and treatment duration typically ranges from 7-14 days depending on infection site, severity, and clinical response. This combination provides broad-spectrum coverage against gram-positive organisms (vancomycin), gram-negative bacteria including Pseudomonas (meropenem), and additional coverage against resistant gram-negatives (amikacin). Due to the nephrotoxicity risk when combining these agents, close monitoring of renal function, electrolytes, and drug levels is crucial throughout treatment, as emphasized by 1.

Some key points to consider:

• The dosing regimens for amikacin, meropenem, and vancomycin should be adjusted based on renal function and therapeutic drug monitoring.
• The combination of these three antibiotics provides broad-spectrum coverage against various pathogens.
• Close monitoring of renal function, electrolytes, and drug levels is essential to minimize the risk of nephrotoxicity and other adverse effects.
• The treatment duration and dosing regimens may need to be adjusted based on the severity of the infection, clinical response, and microbiologic data. The most recent and highest quality study 1 supports the use of optimized antimicrobial dosing strategies in critically ill patients with sepsis and septic shock.

From the Research

Dosing and Usage of Amikacin with Merrem and Vancomycin

• The dosing of Amikacin can be 15 mg/kg body weight given as a 30 min iv infusion, combined with other antibiotics, such as Merrem (meropenem) and Vancomycin (vancomycin) 2.
• Vancomycin can be given intravenously in most cases, usually in a dose of 1 g every 12 hours in patients who have normal renal function 3.
• Merrem (meropenem) can be given as an extended infusion, such as 2 g diluted in 240 ml normal saline over 3 h/8 h, in combination with Amikacin and Vancomycin 4.
• The combination of Amikacin, Merrem, and Vancomycin can be effective in treating severe infections, including Gram-negative multidrug-resistant ventilator-associated pneumonia 4.
• The use of extended infusions of Merrem and nebulized Amikacin may offer efficacy benefits in patients with ventilator-associated pneumonia caused by Gram-negative MDRO 4.

Safety and Efficacy

• The risk of nephrotoxicity may be decreased with a once-daily dosing regimen of Amikacin, but no conclusions could be drawn with regard to ototoxicity 2.
• Vancomycin did not influence the nephrotoxic effect of Amikacin, and both drugs could be used in a combined manner 5.
• The combination of Amikacin, Merrem, and Vancomycin was comparable as regards nephrotoxicity or mortality 4.
• Amikacin at a dose of 15 mg/kg once daily was shown to be as effective as Amikacin (7.5 mg/kg twice daily) in the treatment of intra-abdominal infections in hospitalized adults also treated with metronidazole 6.