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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

AMIKACIN

Use

  • amikacin is an aminoglycoside and possesses the broadest spectrum of antimicrobial activity in this group of antibiotics
  • amikacin has often been reserved for organisms that are gentamicin and tobramycin-resistant

Pharmacology

  • amikacin is an aminoglycoside antibiotic
  • aminoglycosides, which are generally bactericidal, are believed to act by irreversibly binding to 30S ribosomal subunits, thereby inhibiting protein synthesis
  • aminoglycosides are active against many aerobic Gram-negative bacteria and some Gram-positive bacteria; their clinical application is usually reserved for Gram-negative organisms
  • aminoglycosides are inactive against fungi, viruses and most anaerobic bacteria

Side Effects

  • nephro- and oto-toxicity, as with the other aminoglycosides, are the most common side effects seen with amikacin

Precautions

  • serum levels should be monitored and the dose adjusted accordingly
  • specific factors in choosing peak serum levels are the patient's clinical condition, the site of infection and the relative sensitivity of the organism; the following levels have been recommended

    FOR MODERATELY SEVERE SEPSIS

    * peak levels - 20 to 25 mcg/mL
    trough levels - 1 to 4 mcg/mL

    FOR LIFE THREATENING SEPSIS

    * peak levels - 25 to 28 mcg/mL
    trough levels - 4 to 8 mcg/mL

    * peak - level at 30 minutes after the end of a 30 minute infusion

  • 0.25 mL of blood is required for the assay

Drug Interactions

Dose

  • the dosage schedule for neonates has not been firmly established

  • the following schedule has been recommended

    INFANTS LESS THAN (OR EQUAL TO) 30 WEEKS POST CONCEPTION

    9 mg/kg IV q18h

    INFANTS MORE THAN 30 WEEKS POST CONCEPTION

    9 mg/kg/IV q12h

  • give by slow IV infusion over 30 minutes
  • stable in Dextrose and Saline solutions; compatible with KCl
  • compatible with TPN

Reference

  1. Nelson JD: Pocketbook of Pediatric Antimicrobial Therapy, 7th Edition, 1987, Williams and Wilkins, Baltimore.
  2. King JC Guide to Parenteral Admixtures, 1986.
  3. Zaske DE "Aminoglycosides" in Applied Pharmacokinetics, Evans WE, Schentag JJ and Jusko WJ, 2nd Edition, 1986.
  4. Kenyon C, Knoppert D, Lee S, Vandenberghe H and Chance G: Amikacin pharmacokinetics and suggested dosage recommendations for the preterm infant, Antimicrobial Agents and Chemotherapy 1990; 34: 265-268.



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