From the Guidelines
Amikacin is a potent aminoglycoside antibiotic primarily used to treat serious gram-negative bacterial infections, particularly those resistant to other antibiotics, with a recommended dosage of 10-15 mg/kg per day, adjusted according to drug level monitoring, as stated in the most recent guideline [ 1 ]. The use of amikacin is recommended for the treatment of nontuberculous mycobacterial pulmonary disease, including M. avium complex and M. kansasii, in combination with other antibiotics [ 1 ]. Some key points to consider when using amikacin include:
- Monitoring for nephrotoxicity and ototoxicity, with regular assessment of kidney function and drug levels [ 1 ]
- Adjusting the dose according to serum amikacin concentration [ 1 ]
- Using a combination of oral and parenteral antibiotics for the treatment of nontuberculous mycobacterial pulmonary disease [ 1 ]
- Considering the use of amikacin liposome inhalation suspension for refractory disease [ 1 ] It's essential to note that amikacin should be used with caution, especially in patients with renal impairment, and that dose adjustments may be necessary [ 1 ]. Additionally, amikacin has been shown to be effective against certain strains of carbapenem-resistant gram-negative bacilli, but its use should be guided by local antimicrobial susceptibility testing [ 1 ]. Overall, amikacin is a valuable antibiotic for the treatment of serious gram-negative bacterial infections, but its use requires careful monitoring and consideration of potential toxicity.
From the FDA Drug Label
INDICATIONS AND USAGE: Amikacin sulfate injection, USP is indicated in the short-term treatment of serious infections due to susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, species of indole-positive and indole-negative Proteus, Providencia species, Klebsiella species, Enterobacter species, Serratia species, and Acinetobacter species The use of Amikacin is for the short-term treatment of serious infections caused by susceptible Gram-negative bacteria. The main indications include:
- Pseudomonas species
- Escherichia coli
- Proteus species
- Klebsiella species
- Enterobacter species
- Serratia species
- Acinetobacter species 2
From the Research
Use of Amikacin
- Amikacin is a semisynthetic analog of kanamycin, active against most gram-negative bacteria, including gentamicin- and tobramycin-resistant strains 3.
- It is used to treat serious gram-negative bacillary infections, and is the aminoglycoside of choice for treating known or suspected serious gram-negative infections caused by organisms resistant to gentamicin or tobramycin 3.
- Amikacin is effective in treating infections due to gram-negative aerobic bacilli, including acute pyelonephritis, chronic urinary infection, and gram-negative bacteremia 4.
- It is also used in combination with beta-lactam antibiotics to treat immunocompromised or granulocytopenic patients, and exhibits impressive in vitro synergy against aminoglycoside-sensitive and -resistant organisms 3.
- Amikacin has a favorable therapeutic index, and its potential for nephrotoxicity and ototoxicity is not significantly different from that of gentamicin or tobramycin 3.
Clinical Applications
- Amikacin is used to treat severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis 5.
- It is also used for prophylaxis, especially against endocarditis 5.
- Amikacin is effective in treating patients with gram-negative bacteremia, even when caused by gentamicin-resistant bacteria 6.
- It is particularly useful in medical centers where gentamicin resistance is prevalent, as it is the aminoglycoside of choice in such situations 7.
Administration and Safety
- Amikacin can be administered intramuscularly or intravenously, and the dosage is typically 7.5 mg/kg every 12 hours 4.
- Single daily dosing of amikacin is possible, and has the potential for decreased toxicity 5.
- Monitoring for untoward effects, such as eighth nerve toxicity and nephrotoxicity, is necessary during amikacin therapy 4, 6.