Amikacin
Type of Medication: Antibiotic
Indications: Treatment of Pseudomonas aeruginosa, Burkholderia cepacia complex and Mycobacterium abscessus infections
Side Effects: Vestibular and auditory damage, irreversible vestibulocochlear nerve damage, nephrotoxicity, less frequently hypomagnesaemia with prolonged therapy, colitis, nausea, vomiting, hypersensitivity, headaches, rash, fever, paraesthesia, hypocalcaemia, hypomagnesaemia and hypokalaemia, neuromuscular blockade and respiratory paralysis.
Route of administration: Adult (Intravenous)
Dose: 15 mg/kg once daily or 7.5 mg/kg twice daily or 15–25 mg/kg three times per week (BTS guidelines – 2107)
Administration: Give over 60 minutes in 50ml NaCl 0.9%.
Levels: daily dosing – trough: <5 mg/L, peak: 25–35 mg/L. Three time a weeks- 65–80 mg/L – (BTS guidelines – 2107)
Monitoring: Renal function – Monitor twice weekly during month 1, weekly during month 2, then fortnightly to the end of treatment. Consider increasing frequency of monitoring if there is evidence of renal impairment. Auditory and vestibular monitoring Loss of hearing usually occurs first and is detected by regular audiometric testing. Vertigo, loss of balance and auditory disturbances (tinnitus) are also signs of ototoxicity. Ototoxicity on audiogram is defined as a 20 dB loss from baseline at any one test frequency or a 10 dB loss at any two adjacent test frequencies. If this occurs, amikacin should be discontinued or dosing reduced in frequency to avoid further hearing loss, although the hearing loss that has occurred is likely to be permanent.
FBC, U&Es, LFTs should be performed intermittently throughout antibiotic treatment
Route of administration: Adult (Nebulised)
Dose: 500 mg twice daily. In cases of intolerance after an initial initiation period, a dose reduction may be considered to 250–500 mg once or twice daily. In the UK, the injectable preparation is given via the nebulised route, using a suitable nebuliser with filter attachment . The 250 mg/mL injection should be used and made up to 4 mL with sodium chloride 0.9%. Formal assessment with test dose should be undertaken. Amikacin for injection may only be mixed with sodium chloride 0.9%. It must not be nebulised as a mixture with other nebulised drugs (eg, salbutamol, dornase alfa or other nebulised antibiotics).
(Amikacin is not licensed for the treatment of NTM in the UK)
Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations
Route of administration: Paediatric (Intravenous)
Dose: children: usually 15–30 mg/kg daily or 15–30 mg/kg three times per week. Maximum dose 1500 mg daily
Administration: Give over 60 minutes in 50ml NaCl 0.9%.
Levels: daily dosing – trough: <5 mg/L, peak: 25–35 mg/L. Three time a weeks- 65–80 mg/L – (BTS guidelines – 2107)
Monitoring: Renal function – Monitor twice weekly during month 1, weekly during month 2, then fortnightly to the end of treatment. Consider increasing frequency of monitoring if there is evidence of renal impairment. Auditory and vestibular monitoring Loss of hearing usually occurs first and is detected by regular audiometric testing. Vertigo, loss of balance and auditory disturbances (tinnitus) are also signs of ototoxicity. Ototoxicity on audiogram is defined as a 20 dB loss from baseline at any one test frequency or a 10 dB loss at any two adjacent test frequencies. If this occurs, amikacin should be discontinued or dosing reduced in frequency to avoid further hearing loss, although the hearing loss that has occurred is likely to be permanent.
FBC, U&Es, LFTs should be performed intermittently throughout antibiotic treatment
Route of administration: Paediatric (Nebulised)
Dose: 500 mg twice daily. In cases of intolerance after an initial initiation period, a dose reduction may be considered to 250–500 mg once or twice daily. In the UK, the injectable preparation is given via the nebulised route, using a suitable nebuliser with filter attachment . The 250 mg/mL injection should be used and made up to 4 mL with sodium chloride 0.9%. Formal assessment with test dose should be undertaken. Amikacin for injection may only be mixed with sodium chloride 0.9%. It must not be nebulised as a mixture with other nebulised drugs (eg, salbutamol, dornase alfa or other nebulised antibiotics).
(Amikacin is not licensed for the treatment of NTM in the UK)
Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations
Examples of some Drug Interactions
Interacting drug: Alendronate (Bisphosphonates)
increased risk of hypocalcaemia
Interacting drug: Amphotericin
increase risk of nephrotoxicity
Interacting drug: Capreomycin
increased nephrotoxicity and ototoxicity
Interacting drug: Colistin
increased risk of ototoxicity and nephrotoxicity
Interacting drug: Cyclosporin
increased risk of nephrotoxicity and increased levels of both drugs. Reduce aminoglycoside dose is essential and monitor cyclosporin levels carefully
Interacting drug: Frusemide (Loop diuretics)
increase risk of ototoxicity
Interacting drug: Indomethacin
increased plasma concentration of amikacin
Interacting drug: Neostigmine/pyridostigmine
antagonism of effect
Interacting drug: Non-depolarising muscle relaxants
enhances effect e.g. atracurium, vecuronium, pancuronium
Interacting drug: Teicoplanin
increased nephrotoxicity and ototoxicity
Interacting drug: Vancomycin
increased risk of nephrotoxicity and ototoxicity