From the FDA Drug Label
DOSAGE AND ADMINISTRATION: ...The recommended dosage for adults, children and older infants ... with normal renal function is 15 mg/kg/day divided into 2 or 3 equal doses administered at equally-divided intervals, i.e., 7.5 mg/kg q12h or 5 mg/kg q8h. When amikacin is indicated in newborns, it is recommended that a loading dose of 10 mg/kg be administered initially to be followed with 7.5 mg/kg every 12 hours. The total daily dose by all routes of administration should not exceed 15 mg/kg/day. When amikacin is indicated in uncomplicated urinary tract infections, a dose of 250 mg twice daily may be used.
The recommended dose of Amikacin for pediatric patients with Urinary Tract Infections (UTIs) is:
- For children and older infants with normal renal function: 15 mg/kg/day divided into 2 or 3 equal doses
- For newborns: a loading dose of 10 mg/kg followed by 7.5 mg/kg every 12 hours
- The total daily dose should not exceed 15 mg/kg/day 1
From the Research
The recommended pediatric dose of amikacin for urinary tract infections (UTIs) is 15 mg/kg/day once daily, as evidenced by a study published in 2017 2. This dose has been shown to be effective in treating UTIs caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in pediatric patients. The treatment duration typically ranges from 6-7 days, as seen in the study where the median duration of amikacin treatment was 6 days (range 3-7 days) 2. However, it's essential to note that the optimal treatment duration may vary depending on the severity of the infection and the patient's response to treatment. Some studies suggest that longer treatment durations may be associated with lower failure rates, as seen in a meta-analysis published in 2024 3. Key considerations when using amikacin in pediatric patients include:
- Dosing adjustments based on renal function, as amikacin is primarily eliminated by the kidneys
- Therapeutic drug monitoring to minimize toxicity, with peak serum concentrations targeted at 20-30 mcg/mL and trough levels below 5-10 mcg/mL
- Adequate hydration during therapy
- Baseline auditory and renal function tests before initiating treatment, with follow-up monitoring during the course of therapy
- Potential nephrotoxicity and ototoxicity, which may require careful monitoring and dose adjustments. It's also important to consider the severity of the infection, with more severe infections potentially requiring longer treatment durations or higher doses of amikacin. In general, amikacin is effective against many gram-negative pathogens commonly causing UTIs, including Pseudomonas aeruginosa and ESBL-producing organisms. However, due to its potential toxicity, amikacin is typically reserved for serious infections or cases with resistant organisms. Overall, the use of amikacin in pediatric patients with UTIs requires careful consideration of the potential benefits and risks, as well as close monitoring of the patient's response to treatment.