From the Guidelines
Amikacin is a viable option for treating ESBL infections, particularly when used in combination with another antibiotic, as it remains effective against many ESBL-producing organisms due to its mechanism of action not being affected by beta-lactamase enzymes 1.
Key Considerations for Amikacin Use
- The typical adult dosage is 15-20 mg/kg/day given intravenously, usually divided into 2-3 doses, though once-daily dosing may be used in certain settings.
- For serious infections, treatment typically continues for 7-14 days depending on infection severity and clinical response.
- Therapeutic drug monitoring is essential to maintain peak serum concentrations of 20-30 μg/mL and trough levels below 5-10 μg/mL to ensure efficacy while minimizing toxicity risks.
- Important considerations include monitoring renal function before and during treatment, assessing hearing with prolonged therapy, and ensuring adequate hydration to reduce nephrotoxicity risk.
- Amikacin may not be appropriate for patients with significant kidney impairment, hearing disorders, or myasthenia gravis.
Recent Guidelines and Recommendations
- A recent guideline endorsed by the Italian Society of Infection and Tropical Diseases, among others, does not specifically recommend amikacin for the treatment of ESBL infections but highlights the importance of combination therapy for synergistic effects 1.
- The use of amikacin in combination with other antibiotics, such as carbapenems, is supported by its effectiveness against ESBL-producing organisms, as noted in the context of managing infections in patients with decompensated cirrhosis 1.
Toxicity and Safety
- Nephrotoxicity and ototoxicity are significant concerns with amikacin use, with reported rates of nephrotoxicity around 8.7% and significant hearing impairment exceeding 50% in some series 1.
- Monitoring and careful patient selection are crucial to minimize these risks.
Conclusion on Amikacin for ESBL Infections
Given the potential for nephrotoxicity and ototoxicity, amikacin should be used judiciously, with careful monitoring and in combination with other antibiotics when possible, to treat ESBL infections effectively while minimizing risks to the patient 1.
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
- Key points:
- Amikacin is indicated for serious infections due to susceptible strains of Gram-negative bacteria.
- Escherichia coli (which can produce ESBL) is listed as one of the susceptible bacteria.
- Amikacin can be used for ESBL infection, but only if the bacteria are susceptible to amikacin 2.
From the Research
Amikacin for ESBL Infection
- Amikacin is considered an effective alternative treatment option for lower urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae, especially in patients who are resistant to all oral antibiotics 3, 4.
- The clinical success rate of amikacin treatment for ESBL UTIs is high, with a rate of 97.2% reported in one study 3.
- Bacteriological success rates for amikacin treatment of ESBL UTIs are also high, with rates of 91.7% and 97.1% reported at the end of treatment and at follow-up, respectively 3.
- Amikacin can be used in combination with carbapenems, such as meropenem and imipenem, to achieve synergistic activity against KPC-producing Klebsiella pneumoniae 5.
- However, the use of amikacin for ESBL infections is not universally recommended, and carbapenems are still considered the first-line choice for serious ESBL infections 6, 7.
- New beta-lactams/beta-lactamase inhibitors, such as ceftazidime-avibactam and ceftolozane-tazobactam, are being developed as alternative treatments for ESBL infections, but further clinical data are needed to establish their efficacy relative to carbapenems 7.
Limitations and Considerations
- The use of amikacin for ESBL infections may be limited by its potential for nephrotoxicity and ototoxicity, although these side effects were not commonly reported in the studies reviewed 3, 4.
- The efficacy of amikacin for ESBL infections may vary depending on the specific strain of bacteria and the severity of the infection 6, 7.
- Further studies are needed to fully establish the role of amikacin in the treatment of ESBL infections and to determine the optimal dosing and duration of treatment 3, 7.