What is the dose of Amikacin (an aminoglycoside antibiotic) in patients with Impaired renal function undergoing dialysis?

From the Guidelines

For patients with impaired renal function undergoing dialysis, the recommended dose of amikacin is 12-15 mg/kg given two or three times a week, with the dose maintained to take advantage of the concentration-dependent bactericidal effect, as stated in the American Thoracic Society guidelines 1.

Key Considerations

• The dosing frequency should be reduced to two or three times a week to account for the patient's impaired renal function.
• The dose should be maintained at 12-15 mg/kg to ensure the concentration-dependent bactericidal effect of amikacin.
• Amikacin should be given after dialysis to facilitate drug administration and avoid premature removal of the drug.
• Serum drug concentrations should be monitored to avoid toxicity, as recommended by the guidelines 1.

Dosing Strategy

• The post-dialysis dosing strategy ensures adequate antimicrobial coverage while reducing the risk of nephrotoxicity and ototoxicity.
• Therapeutic drug monitoring is essential when using amikacin in dialysis patients, with pre-dialysis trough levels ideally below 5-10 mg/L to minimize toxicity risks.
• Peak levels should be measured 30-60 minutes after infusion and typically target 20-35 mg/L for effectiveness, although the guidelines do not specify exact peak levels 1.

Adjustments and Monitoring

• The dosing may need adjustment based on the specific dialysis modality (hemodialysis, peritoneal dialysis, or continuous renal replacement therapy) and the patient's residual renal function.
• Regular monitoring of serum drug concentrations and adjustment of the dosing regimen as needed is crucial to minimize the risk of toxicity and ensure effective treatment.

From the FDA Drug Label

Neither method should be used when dialysis is being performed. The dose of Amikacin in patients with impaired renal function undergoing dialysis is not directly stated in the label. Dosing in patients undergoing dialysis is not provided. 2

From the Research

Dosing of Amikacin in Patients with Impaired Renal Function Undergoing Dialysis

• The dose of Amikacin in patients with impaired renal function undergoing dialysis should be adjusted based on the degree of renal impairment and the type of dialysis [(3,4,5)].
• For patients undergoing hemodialysis, a dose of 5 mg/kg every two days has been suggested 4.
• For patients undergoing continuous ambulatory peritoneal dialysis, a dose of 4 mg/kg every two days has been suggested 4.
• The pharmacokinetics of Amikacin are significantly altered in patients with impaired renal function, with a decreased elimination rate and an increased volume of distribution [(6,7)].
• The half-life of Amikacin is prolonged in patients with impaired renal function, and is further affected by the type of dialysis [(3,5,7)].
• Monitoring of serum Amikacin levels is essential to prevent cumulative toxicity and ensure effective therapy [(3,4)].
• The dosage regimen should be individualized based on the patient's renal function, with more frequent dosing required for patients with less severe renal impairment [(4,6)].
• Amikacin trough levels are associated with effective therapy in patients with chronic kidney disease, and should be monitored to ensure adequate drug levels 4.