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(C) Vancouver
General Hospital.
This monograph may not be reproduced without permission.
For further information, please contact a Pharmacist. |
NAME OF DRUG
amikacin sulphate
CLASSIFICATION
Aminoglycoside Antibiotic
ALTERNATE NAME
AMIKIN
INDICATIONS
- treatment of serious infections caused by susceptible strains of gram-negative bacteria
with highly suspected or documented resistance to gentamicin and tobramycin
RECONSTITUTION AND STABILITY
- stable at room temperature
- pale yellow solution does not indicate loss in potency; dark coloured solutions should
be discarded.
COMPATIBILITY
- compatible with most commonly used IV solutions
- compatible via Y-site with acyclovir, aminophylline, calcium chloride, calcium
gluconate, cefazolin, ciprofloxacin, clindamycin, cloxacillin, cyclosporine,
dimenhydrinate, diphenhydramine, fluconazole, furosemide, levofloxacin,
lorazepam, magnesium
sulphate, meperidine, metronidazole,
morphine, ondansetron, penicillin G, potassium chloride, ranitidine, sodium bicarbonate, vancomycin, vitamin K
ROUTES OF ADMINISTRATION
- IM
- IV intermittent - dilute each dose to 50-200 mL and administer over 30 minutes
- central line - dilute in 25 mL IV solution if fluid restricted
VH & HSC ADMINISTRATION POLICY
A - Not to be administered by the direct IV route.
DOSAGE
Adults:
Dosage should be based on ideal body weight (IBW).
In obese patients (total body weight (TBW) >125% IBW), dosage is based on IBW +
0.4(TBW-IBW).
Conventional Multiple Daily Dosing:
- Usual: 15 mg/kg/day divided every 8-12 hours
- Dosing adjustments are necessary in renal impairment.
Contact Pharmacy for dosing guidelines.
- Monitoring of serum drug levels is recommended in view of
high patient variability in aminoglycoside clearance.
Once Daily Dosing:
|
Creatinine Clearance |
Dose |
|
≥ 60
mL/minute |
15
mg/kg q24h |
|
40-59 mL/minute |
15
mg/kg q36h; pre-dose level recommended |
|
< 40
mL/minute |
Use
conventional dosing – take two post-dose levels to determine appropriate
interval |
- Exclusions to once daily dosing: burns > 20%, pregnancy,
dialysis, synergy against gram-positive organisms, cystic fibrosis, surgical
or diagnostic procedure prophylaxis, in-patients undergoing stem cell
transplantation or receiving chemotherapy for a hematologic malignancy,
septic shock
Children: 5 - 7.5 mg/kg every 8 hours
POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION
- hypersensitivity reactions
- pain at IM injection site
- thrombophlebitis on IV administration
IMPORTANT IMPLICATIONS
- adverse effects include ototoxicity, nephrotoxicity and
neurotoxicity,
- adverse effects are potentiated by other ototoxic or
nephrotoxic drugs
- apnea may result when combined with anesthetics or other
neuromuscular blocking agents
- use with caution in patients with impaired renal function
- maintain good hydration, monitor renal function,
intake/output
- serum levels in serious life-threatening infections:
- conventional dosing: - Pre-dose level should be less
than 10 mg/L
- Post-dose level should 25-30 mg/L
- once daily dosing: -
Pre-dose levels should be negligible (< 1 mg/L)
- blood specimens for post-dose levels should be drawn:
i. 30 minutes after completion of IV infusion
ii. approximately 1 hour after an IM dose
Rev. June 2008