Amikacin

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Monitoring: 

Consult with pharmacy 

Dosing: Adult Antimicrobial Dosing, Non-dialysis

For UCSF pharmacists, access the pharmacy guidance manual click here

Do not use high-dose extended interval dosing strategy (using Barnes Jewish nomogram) in the following populations:

- Cr Cl ≤ 20 ml/min

- Aminoglycoside t ½ > 4.5 hours

- Patients with burns > 20% total burn surface area (TBSA)

- Ascites

- Cystic Fibrosis (CF) patients

- Pregnancy (outside of surgical prophylaxis)

- Spinal cord injury

High-dose extended dosing strategy (Barnes Jewish nomogram):

Indication CrCl > = 60 mL/min 40-59 mL/min 21-39 mL/min CrCl < = 20 mL/min Comments
Cystitis 15 mg/kg x 1  15 mg/kg x1  15 mg/kg x 1 Use conventional/traditional dosing No nomogram or levels needed
Non-TB mycobacerium 20 mg/kg thrice weekly 20 mg/kg thrice weekly 20 mg/kg thrice weekly Use conventional traditional dosing

Use 15 mg/kg dosing for elderly/frail/small patients

Contact ID pharmacy for suggested monitoring and therapeutic drug targets
Other infections (exclude CF) 15 mg/kg IV q 24h 15 mg/kg IV q36h 15 mg/kg IV q 48h Use conventional/traditional dosing 

Obtain 6-14 hour random amikacin level after first dose to inform future dosing interval

Consider consulting pharmacy to assist with suggested dosing and monitoring

Use Barnes Jewish  dosing nomogram

Do not use this dosing in CF patients

 

Conventional/traditional dosing:

Please consult pharmacy to help with dosing and monitoring plan.  Below are suggested peak and trough goals based upon infection:

Conventional/Traditional Dosing for Amikacin

Infection 

Extrapolated  

Peak Goal  

Extrapolated  

Trough Goal  

Abdominal Infections (including peritonitis)  

35 (25-35) 

< 5 

Bacteremia 

25 (20-30) 

< 5 

Empiric therapy for Cystic Fibrosis (if cannot do high-dose extended interval dosing)

35 (25-35) 

< 5 

Febrile Neutropenia

35 (25-35) 

< 5 

Pneumonia 

35 (25-35) 

< 5 

Skin and soft tissue 

infections 

25 (20-30) 

< 5 

Urinary tract infections (including pyelonephritis) 

15-20 

< 5 

Cystic fibrosis (CF) patients:

Prior to choosing a dosing regimen the clinical pharmacist should review the patient’s previous aminoglycoside  regimen(s) to determine if information from previous courses of therapy can aid n selecting dosing for a new course of treatment.  Please contact pharmacy for assistance.  If no history of previous doses and levels, then follow the below:

Indication CrCl > = 60 mL/min 40-59 mL/min 21-39 mL/min CrCl < = 20 mL/min Comments
CF exacerbation 20 mg/kg IV q 24h 20 mg/kg IV q36h 20 mg/kg IV q48h Use conventional/traditional dosing

Do not use Barnes Jewish nomogram

With first dose, obtain two serum concentrations 2 hours and 6 hours (10 hours in impaired renal function, elderly), counting from the start of the infusion. This typically allows for 2 half-lives to pass between levels. Periodically, it may help to have a third level (trough) if needed for additional calculations.  Consult pharmacy to assist.
Aminoglycoside for CF Target peak Target trough
Amikacin  35-45 mcg/mL*  < 5 mcg/mL  

*There may be instances (e.g., elevated MIC) where the targeted peak may need to go up to 40- 60 mcg/mL - contact adult ID pharmacist.   

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Intermittent Hemodialysis Continuous Hemodialysis
All indications 

Use conventional/traditional dosing 

Consult pharmacy to assist 

Consult pharmacy to assist with dosing strategy

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.

Advise caution in individuals with myasthenia gravis. Aminoglycosides should never be used as monotherapy except in the setting for a urinary tract infection (UTI). 

Restricted to ID or Antimicrobial Stewardship for IV amikacin 

References: