From the Guidelines
Amikacin is not recommended as a first-line treatment for UTIs due to its potential for nephrotoxicity and ototoxicity, and its use should be reserved for complicated UTIs or when first-line agents have failed, with a recommended dose of 15 mg/kg/day and duration of 7-14 days, as supported by 1. The use of amikacin for UTIs should be guided by the severity of the infection, the presence of complicating factors, and the susceptibility of the causative organism.
- For uncomplicated UTIs, first-line agents such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin are recommended, as stated in 1.
- For complicated UTIs, including pyelonephritis, the recommended duration of antibiotic therapy is 7-14 days, with amikacin being an option for treatment, as noted in 1. Key considerations when using amikacin include:
- Renal function assessment before starting therapy, as amikacin requires dose adjustment in patients with impaired kidney function.
- Therapeutic drug monitoring, with peak levels drawn 30-60 minutes after infusion and trough levels before the next dose.
- Maintenance of adequate hydration during treatment.
- Reservation of amikacin for use in hospitalized patients with serious infections, due to its poor oral bioavailability and potential for adverse effects. It is essential to note that the use of amikacin should be guided by the most recent and highest-quality evidence, and its use should be tailored to the individual patient's needs and circumstances, as supported by 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: ... When amikacin is indicated in uncomplicated urinary tract infections, a dose of 250 mg twice daily may be used. The usual duration of treatment is 7 to 10 days.
The proper dose of Amikacin for UTI is 250 mg twice daily. The recommended duration of treatment is 7 to 10 days 2.
From the Research
Amikacin Dosage and Duration for UTI
- The recommended dose of amikacin for UTI varies, with studies suggesting 7.5 mg/kg twice daily 3, 15 mg/kg/day for 10 days 4, and 15 mg/kg/day once daily for 6 days (range 3-7 days) in pediatric patients 5.
- A comparative study found that low dosage amikacin (7.5 mg/Kg) was satisfactory in the treatment of complicated urinary tract infections, with comparable bacteriologic results to the recommended dose of 15 mg/Kg 6.
- The duration of treatment also varies, with studies ranging from 6 days 5 to 10 days 4.
Efficacy and Safety of Amikacin for UTI
- Amikacin has shown high clinical success rates, with 97.2% of patients achieving clinical success in one study 4 and 96% of pediatric patients showing favorable clinical and bacteriological responses in another study 5.
- Bacteriological success rates were also high, with 91.7% of patients achieving sterile control urine cultures on the 3rd day of treatment and 94.1% on the 7-10 days after treatment 4.
- Amikacin was found to be safe, with no significant nephrotoxicity or ototoxicity observed in most studies 4, 3, 6, 5, 7.
Specific Patient Populations
- In pediatric patients, once-daily intramuscular amikacin was found to be an effective and safe alternative option for outpatient treatment of community-acquired lower UTIs caused by ESBL-producing E. coli 5.
- In patients with limited resources, amikacin outpatient parenteral antibiotic therapy (OPAT) was found to be a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC 7.