Is Amikacin (generic name) effective for treating serrations pneumonia, also known as crenated pneumonia or more accurately, what is the role of Amikacin in the management of pneumonia with serrated or crenated appearance on imaging, specifically for a patient with pneumonia characterized by serrations?

From the Guidelines

Amikacin is an appropriate antibiotic choice for treating Serratia pneumonia, particularly in cases of severe infection or when resistance to other antibiotics is suspected. The recommended dosage for adults with normal renal function is typically 20 mg/kg per day, as indicated in the guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia 1. Treatment duration is usually 7-14 days, depending on clinical response. Amikacin should be administered intravenously for pneumonia, and therapeutic drug monitoring is essential to maintain peak serum concentrations and trough levels below 4-5 μg/mL to prevent toxicity, as suggested by the guidelines 1. Renal function should be monitored closely during treatment, with dose adjustments necessary for patients with impaired kidney function. Some key points to consider when using amikacin for Serratia pneumonia include:

• Amikacin is effective against Serratia marcescens because it's an aminoglycoside that works by binding to bacterial ribosomes and inhibiting protein synthesis.
• Serratia species are often resistant to multiple antibiotics, including many beta-lactams, making aminoglycosides like amikacin valuable treatment options.
• Amikacin is typically used in combination with another antibiotic such as a beta-lactam or fluoroquinolone for synergistic effect and to prevent the development of resistance during treatment.
• The use of amikacin should be guided by the results of susceptibility testing and the clinical response of the patient, as recommended by the guidelines for the management of community-acquired pneumonia in adults 1. It's also important to note that amikacin can be associated with renal, auditory, and vestibular toxicity, as mentioned in the treatment of nontuberculous mycobacterial pulmonary disease guidelines 1. Therefore, amikacin should be used with caution and close monitoring in patients with Serratia pneumonia, particularly in cases of severe infection or when resistance to other antibiotics is suspected.

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 Antibacterial Activity Amikacin has been shown to be active against the following bacteria, both in vitro and in clinical infections (see INDICATIONS AND USAGE) Gram-Positive Bacteria Staphylococcus species Gram-Negative Bacteria Pseudomonas species Escherichia coli Proteus species (indole-positive and indole-negative) Klebsiella species Enterobacter species Serratia species Acinetobacter species

Amikacin can be used for the treatment of Serratia infections, including Serratia pneumonia, as it has been shown to be active against Serratia species both in vitro and in clinical infections 2 2.

• Key points:
  • Indication: Short-term treatment of serious infections due to susceptible strains of Gram-negative bacteria, including Serratia species.
  • Antibacterial activity: Active against Serratia species both in vitro and in clinical infections.

From the Research

Amikacin for Serrations Pneumonia

• There is limited information available on the use of amikacin for serrations pneumonia. However, amikacin is an aminoglycoside antibiotic that is commonly used to treat various types of bacterial infections, including pneumonia 3.
• A study published in 2001 compared the efficacy and tolerability of piperacillin/tazobactam versus ceftazidime in association with amikacin for treating nosocomial pneumonia in intensive care patients. The results showed that both regimens had similar efficacy and tolerability 4.
• Another study published in 2005 discussed the importance of choosing an appropriate antibiotic regimen for the treatment of severe pneumonia, including nosocomial pneumonia. The study recommended the use of broad-spectrum antibiotics, including aminoglycosides such as amikacin, in combination with other antibiotics to provide adequate coverage against Gram-negative and Gram-positive bacteria 3.
• A 2020 study compared the clinical benefits of piperacillin/tazobactam versus a combination of ceftriaxone and clindamycin in the treatment of early, non-ventilator, hospital-acquired pneumonia. The results showed that piperacillin/tazobactam was more effective than the combination of ceftriaxone and clindamycin in patients with early non-ventilator hospital-acquired pneumonia 5.
• A 2017 study found that switching from broad-spectrum intravenous antibiotic coverage to a narrow-spectrum oral antibiotic once clinical stability is achieved may be safe for hospitalized patients with health care-associated pneumonia when no microbiological diagnosis is made 6.
• A 2002 study emphasized the importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU, where broad-spectrum antibiotics are initially used and then modified based on microbiologic testing results to reduce the risk of resistance and improve outcomes 7.