From the Guidelines
The therapeutic range for amikacin is typically 15-25 mcg/mL for peak serum concentrations and less than 5-10 mcg/mL for trough concentrations, as recommended by the most recent guidelines 1. When administering amikacin, peak levels should be drawn 30 minutes after completion of the infusion, while trough levels should be obtained just before the next scheduled dose.
Key Considerations
- Amikacin is typically dosed at 10-15 mg/kg per day, adjusted according to drug level monitoring, for adults with normal renal function, often given as a single daily dose 1.
- The once-daily dosing strategy maximizes the concentration-dependent killing effect while potentially reducing toxicity by allowing a drug-free interval.
- Dose adjustments are necessary for patients with renal dysfunction, and therapeutic drug monitoring is essential to maintain efficacy while minimizing adverse effects.
- Extended-interval dosing (once daily) has become preferred in many clinical settings due to its favorable pharmacokinetic profile.
Monitoring and Adjustments
- Peak levels should be drawn 30 minutes after completion of the infusion, while trough levels should be obtained just before the next scheduled dose.
- Trough levels should be less than 5 mg/L, and peak levels with daily dosing should be 35-45 μg/mL, while peak levels with intermittent dosing should be 65-80 μg/mL 1.
- Adjustments to the dose and/or frequency of amikacin administration should be made according to serum amikacin concentration, with careful consideration of the patient's renal function and potential for nephrotoxicity and ototoxicity.
From the FDA Drug Label
Peak concentrations (30 to 90 minutes after injection) above 35 micrograms per mL and trough concentrations (just prior to the next dose) above 10 micrograms per mL should be avoided.
The therapeutic range of Amikacin is:
- Peak concentration: below 35 micrograms per mL
- Trough concentration: below 10 micrograms per mL 2
From the Research
Therapeutic Range of Amikacin
The therapeutic range of Amikacin is a critical aspect of its administration, as it directly impacts the drug's efficacy and potential toxicity.
- The target peak concentrations for Amikacin have been reported to range from 15 to 40 mg/L, with trough concentrations typically being less than 10 or 5 mg/L 3.
- A study found that a peak concentration of 30-40 mg/L was necessary to achieve optimal therapeutic effects in pediatric patients, with a loading dose of 20 mg/kg recommended 4.
- In patients with severe sepsis or septic shock, a target peak concentration of 60-80 mg/L has been recommended, corresponding to approximately 8 times the MIC breakpoint 5.
- However, it is essential to note that Amikacin concentrations above 80 mg/L may be associated with increased mortality, highlighting the need for careful therapeutic drug monitoring 5.
- Another study suggested that a Cmin (trough concentration) of more than 5 mg/L may be potentially nephrotoxic 6.
Factors Influencing Therapeutic Range
Several factors can influence the therapeutic range of Amikacin, including:
- Renal function: Patients with impaired renal function may require adjusted dosing to avoid toxicity 6, 7.
- Age: Pediatric patients may require individualized dosing due to wide interpatient variability in pharmacokinetic parameters 4.
- Disease severity: Patients with severe sepsis or septic shock may require higher loading doses to achieve optimal peak concentrations 5.