What is the recommended dosage and route of administration for Amikacin (generic name)?

From the Guidelines

Amikacin should be administered at a dose of 15 mg/kg once daily via intravenous (IV) injection for most serious infections in adults with normal renal function, as recommended by the British Thoracic Society guidelines 1. The dosage and route of administration for Amikacin can vary depending on the patient population and renal function.

Key Considerations

• For adults, the recommended dose is 15 mg/kg once daily or 7.5 mg/kg twice daily, or 15–25 mg/kg three times per week, administered intravenously 1.
• In obese patients, the dose should be adjusted using ideal body weight plus 40% of the excess weight, to account for the decreased distribution of extracellular fluids in adipose tissues 1.
• For children, the recommended dose is usually 15–30 mg/kg daily or 15–30 mg/kg three times per week 1.
• The dose and frequency of Amikacin should be adjusted according to serum concentrations, with target peak serum concentrations of 20-35 μg/mL and trough levels below 5-10 μg/mL to ensure efficacy while minimizing toxicity.

Administration Route

• Amikacin is typically administered via intravenous (IV) injection, as recommended by the British Thoracic Society guidelines 1.
• The IV route is preferred due to its enhanced efficacy and reduced risk of nephrotoxicity compared to other routes of administration.

Special Populations

• In patients with impaired kidney function, dosage adjustment is necessary based on creatinine clearance, often requiring reduced doses or extended intervals between doses.
• For neonates and pediatric patients, the recommended dose and frequency of Amikacin vary depending on gestational age and postnatal age, as outlined in the guidelines for the treatment of multidrug-resistant infections 1.

Monitoring and Safety

• Therapeutic drug monitoring is essential during treatment with Amikacin, to ensure efficacy and minimize toxicity.
• Patients should be monitored for potential side effects, including nephrotoxicity and ototoxicity, particularly with prolonged therapy or in patients with pre-existing renal impairment.

From the FDA Drug Label

Both methods are based on the patient's creatinine clearance or serum creatinine values since these have been found to correlate with aminoglycoside half-lives in patients with diminished renal function. The total daily dose should not exceed 15 mg/kg/day and may be divided into either 2 or 3 equally-divided doses at equally-divided intervals The solution is administered to adults over a 30 to 60 minute period. Intravenous Administration The individual dose, the total daily dose, and the total cumulative dose of amikacin sulfate are identical to the dose recommended for intramuscular administration

The recommended dosage of Amikacin is 15 mg/kg/day, which can be divided into 2 or 3 equally-divided doses. The route of administration is either intravenous or intramuscular. The intravenous solution should be administered over a 30 to 60 minute period 2.

• Key considerations:
  • Dosage should be based on the patient's creatinine clearance or serum creatinine values.
  • The solution should not be physically premixed with other drugs.
  • Aminoglycosides should be administered separately according to the recommended dose and route.

From the Research

Amikacin Dosage and Route of Administration

The recommended dosage and route of administration for Amikacin vary depending on the patient's condition and the severity of the infection.

• The dosage of Amikacin can range from 15 mg/kg to 25 mg/kg per day, administered intravenously or intramuscularly, as seen in studies 3, 4, 5.
• For patients with chronic kidney disease, the dosage may need to be adjusted based on the stage of kidney disease, with lower doses and longer intervals between doses, as suggested by study 6.
• The route of administration is typically intravenous or intramuscular, with intravenous administration being more common in critically ill patients, as seen in study 5.

Factors Affecting Amikacin Dosage

Several factors can affect the dosage of Amikacin, including:

• Renal function: Patients with impaired renal function may require lower doses and longer intervals between doses, as seen in study 7.
• Body mass index (BMI): Patients with a low BMI may be at risk of underdosing, as suggested by study 5.
• Fluid balance: Patients with a positive 24-hour fluid balance may require higher doses to achieve adequate therapeutic targets, as seen in study 5.

Dosage Regimens

Different dosage regimens have been studied, including:

• Once-daily dosing: This regimen has been shown to be effective and may reduce the risk of nephrotoxicity, as seen in study 3.
• Twice-daily dosing: This regimen may be less effective than once-daily dosing, especially in patients with stage 4 chronic kidney disease, as suggested by study 6.
• Every 2-day dosing: This regimen may be less effective than daily dosing in patients with stage 4 chronic kidney disease, as seen in study 6.