From the Guidelines
Amikacin is not the first-line treatment for ESBL skin infections, and carbapenems like meropenem or imipenem are generally preferred as first-line agents. For ESBL skin infections, the use of amikacin is typically considered in patients with documented beta-lactam allergy, as stated in the 2017 WSES guidelines for management of intra-abdominal infections 1. If amikacin is used, the typical adult dosage is 15-20 mg/kg/day given once daily, with duration typically 7-14 days depending on infection severity. Amikacin requires therapeutic drug monitoring due to its potential for nephrotoxicity and ototoxicity, with trough levels kept below 5-10 mcg/mL. Renal function should be monitored closely during treatment.
- The 2024 WHO essential medicines and aware recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections do not specifically mention amikacin as a first-line treatment for ESBL skin infections 1.
- The 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections recommends vancomycin plus one of the following: ceftazidime, cefepime, piperacillin-tazobactam, aztreonam, or a carbapenem for severe infections, but does not mention amikacin as a first-line treatment 1.
- Local susceptibility patterns should guide therapy, as resistance rates vary by region.
- For outpatient management, other oral options like fosfomycin or nitrofurantoin might be considered if susceptibility is confirmed.
- Amikacin works by binding to bacterial ribosomes and inhibiting protein synthesis, and it remains active against many ESBL-producing organisms because aminoglycosides are not affected by beta-lactamase enzymes.
- However, amikacin is usually combined with another antibiotic for synergistic effect rather than used as monotherapy.
From the Research
Amikacin for ESBL Skin Infection
- There is limited research on the use of amikacin for ESBL skin infections, as most studies focus on urinary tract infections or other types of infections 2, 3, 4.
- However, amikacin has been shown to be effective against ESBL-producing bacteria in various studies, including those on urinary tract infections 2, 3, 4.
- One study found that amikacin was effective in treating urinary tract infections caused by ESBL-producing Escherichia coli, with a clinical success rate of 97.2% and a bacteriological success rate of 91.7% 3.
- Another study found that amikacin was effective in treating lower urinary tract infections caused by ESBL-producing bacteria, with a clinical success rate of 97.2% and a bacteriological success rate of 94.1% 3.
- Amikacin has also been shown to be effective in combination with other antibiotics, such as piperacillin-tazobactam, against ESBL-producing bacteria 4.
- However, it is essential to note that the use of amikacin for ESBL skin infections may require careful consideration of the patient's individual characteristics and the specific infection being treated, as well as the potential for resistance and side effects 5.
Considerations for Use
- The use of amikacin for ESBL skin infections should be guided by susceptibility testing and clinical experience 2, 3, 4.
- Amikacin may be considered as an alternative to carbapenems in certain cases, such as when carbapenem use is not feasible or when the patient has a history of carbapenem resistance 4, 5.
- However, the use of amikacin should be carefully monitored for potential side effects, such as nephrotoxicity and ototoxicity 2, 3.