What is the recommended dose of amikacin (Intramuscular injection amikacin) for children?

Amikacin Dosage for Children

The recommended dose of amikacin for children is 15-30 mg/kg/day as a single daily dose, with adjustments based on age and clinical condition. 1

Standard Dosing Recommendations

• Infants and Children:

  • 15-30 mg/kg/day as a single daily dose 2, 1
  • Maximum dose: 1 gram per day 2
  • For twice-weekly dosing (e.g., in tuberculosis treatment): 15-30 mg/kg per dose 2

• Neonates:

  • Dosing varies based on gestational and postnatal age 1
  • Initial loading dose of 10 mg/kg followed by 7.5 mg/kg every 12 hours 3

Administration Routes

• Intramuscular (IM): Preferred route for many pediatric patients
• Intravenous (IV): Should be infused over 30-60 minutes 1

Monitoring Requirements

Therapeutic drug monitoring is essential to ensure efficacy while minimizing toxicity:

• Target Levels:

  • Peak concentrations: 25-35 μg/mL 1
  • Trough concentrations: <5-10 μg/mL 1
  • Avoid peak concentrations above 35 μg/mL and trough concentrations above 10 μg/mL 3

• Monitoring Schedule:

  • Renal function: Monthly
  • Auditory and vestibular function: Monthly
  • Serum amikacin levels: Regularly throughout treatment 1

Special Considerations

• Renal Impairment: Dose adjustment required based on creatinine clearance or serum creatinine 3

  • Either reduce dose or extend dosing interval

• Specific Conditions:

  • Cystic fibrosis or febrile neutropenia: Higher doses of 30 mg/kg/day divided every 8 hours may be needed 1
  • For uncomplicated urinary tract infections: Lower doses may be effective 3

• Treatment Duration:

  • Usual duration: 7-10 days 3
  • Limit treatment to short term whenever possible
  • For treatment beyond 10 days, careful monitoring of serum levels and renal/auditory function is essential 3

Evidence-Based Considerations

Recent pharmacokinetic studies suggest that once-daily dosing of 20 mg/kg provides better target attainment with lower toxicity compared to multiple daily doses 4, 5. This approach achieves higher peak concentrations which enhance the concentration-dependent bactericidal effect while allowing longer drug-free periods to reduce toxicity 1.

Cautions and Pitfalls

• Very Low Birth Weight Infants: Standard dosing may result in excessive serum levels in infants ≤1000g 6
• Preterm Infants: Require adjusted dosing based on postconceptional age due to longer half-life and reduced clearance 7
• Monitoring: Failure to monitor drug levels may lead to toxicity, particularly in neonates and infants with immature renal function
• Toxicity: Watch for signs of ototoxicity and nephrotoxicity, especially with prolonged treatment

Clinical Response Assessment

Treatment response should be evident within 24-48 hours for uncomplicated infections. If no clinical improvement occurs within 3-5 days, therapy should be reevaluated and antibiotic susceptibility rechecked 3.