Amikacin Sulfate

AMIKACIN SULFATE
(am-i-kay'sin)
Amikin
Classifications: ANTIINFECTIVE; AMINOGLYCOSIDE ANTIBIOTIC
Prototype: Gentamicin
Pregnancy Category: C
Availability
250 mg/mL, 50 mg/mL injection
Actions
Semisynthetic derivative of kanamycin with broad range of antimicrobial activity that
includes many strains resistant to other aminoglycosides. Pharmacologic properties are
essentially the same as those of gentamicin. Appears to inhibit protein synthesis in
bacterial cell and is usually bactericidal.
Therapeutic Effects
Effective against a wide variety of gram-negative bacteria including Escherichia coli,
Enterobacter, Klebsiella pneumoniae, most strains of Pseudomonas aeruginosa, and
many strains of Proteus species, Serratia, Providencia stuartii, Citrobacter freundii,
Acinetobacter. Also effective against penicillinase- and non-penicillinase-producing
Staphylococcus species, and against Mycobacterium tuberculosis and atypical
mycobacteria.
Uses
Primarily for short-term treatment of serious infections of respiratory tract, bones, joints,
skin, and soft tissue, CNS (including meningitis), peritonitis burns, recurrent urinary tract
infections (UTIs).
Unlabeled Uses
Intrathecal or intraventricular administration, in conjunction with IM or IV dosage.
Contraindications
History of hypersensitivity or toxic reaction with an aminoglycoside antibiotic. Safety
during pregnancy (category C), lactation, neonates and infants, or use period exceeding
14 d is not established.
Cautious Use
Impaired renal function; eighth cranial (auditory) nerve impairment; preexisting vertigo
or dizziness, tinnitus, or dehydration; fever; older adults, premature infants, neonates and
infants; myasthenia gravis; parkinsonism; hypocalcemia.
Route & Dosage
Moderate to Severe Infections

Adult: IV/IM 5–7.5 mg/kg loading dose, then 7.5 mg/kg q12h
Child: IV/IM 5–7.5 mg/kg loading dose, then 5 mg/kg q8h or 7.5 mg/kg q12h
Neonate: IV/IM 10 mg/kg loading dose, then 7.5 mg/kg q12–24h
Uncomplicated UTI
Adult: IV/IM 250 mg q12h
Administration
Intramuscular
• Use the 250 mg/mL vials for IM injection. Calculate the required dose and
withdraw the equivalent number of mLs from the vial.
• Give deep IM into a large muscle.
Intravenous
• Verify correct IV concentration and rate of infusion with physician for neonates,
infants, and children.
PREPARE: Intermittent: • Add contents of 500 mg vial to 100 or 200 mL D5W, NS

injection, or other diluent recommended by manufacturer.• For pediatric patients, volume
of diluent depends on patient's fluid tolerance.• Note: Color of solution may vary from
colorless to light straw color or very pale yellow. Discard solutions that appear discolored
or that contain particulate matter.
ADMINISTER: Intermittent: • Give a single adult dose (including loading dose) over at
least 30–60 min by IV infusion.• Increase infusion time to 1–2 h for infants.• Monitor drip
rate carefully. A rapid rise in serum amikacin level can cause respiratory depression
(neuromuscular blockade) and other signs of toxicity.
INCOMPATIBILITIES Solution/additive: aminophylline, amphotericin B,

CEPHALOSPORINS, chlorothiazide, erythromycin, heparin, oxytetracycline,
PENICILLINS, phenytoin, thiopental, vitamin B complex with C, warfarin. Y-site:
amphotericin B, heparin, phenytoin, thiopental.
• Store at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects ( 1%)
CNS: Neurotoxicity: drowsiness, unsteady gait, weakness, clumsiness, paresthesias,
tremors, convulsions, peripheral neuritis. Special Senses: Auditory–ototoxicity, high-
frequency hearing loss, complete hearing loss (occasionally permanent); tinnitus; ringing
or buzzing in ears; Vestibular: dizziness, ataxia. GI: Nausea, vomiting, hepatotoxicity.
Metabolic: Hypokalemia, hypomagnesemia. Skin: Skin rash, urticaria, pruritus, redness.
Urogenital: Oliguria, urinary frequency, hematuria, tubular necrosis, azotemia. Other:
Superinfections.
Interactions
Drug: ANESTHETICS, SKELETAL MUSCLE RELAXANTS have additive neuromuscular
blocking effects; acyclovir, amphotericin B, bacitracin, capreomycin, cephalosporins,
colistin, cisplatin, carboplatin, methoxyflurane, polymyxin B, vancomycin,
furosemide, ethacrynic acid increase risk of ototoxicity and nephrotoxicity.
Pharmacokinetics
Peak: 30 min IV; 45 min to 2 h IM. Distribution: Does not cross blood–brain barrier;
crosses placenta; accumulates in renal cortex. Elimination: 94%–98% excreted renally in
24 h, remainder in 10–30 d. Half-Life: 2–3 h in adults, 4–8 h in neonates.
NURSING IMPLICATIONS
Assessment & Drug Effects
• Baseline tests: Before initial dose, C&S; renal function and vestibulocochlear
nerve function (and at regular intervals during therapy; closely monitor in the
older adult, patients with documented ear problems, renal impairment, or during
high dose or prolonged therapy).
• Monitor peak and trough amikacin blood levels: Draw blood 1 h after IM or
immediately after completion of IV infusion; draw trough levels immediately
before the next IM or IV dose.
• Lab tests: Periodic serum creatinine and BUN, complete urinalysis. With
treatment over 10 d, daily tests of renal function, weekly audiograms, and
vestibular tests are strongly advised.
• Monitor serum creatinine or creatinine clearance (generally preferred) more often,
in the presence of impaired renal function, in neonates, and in the older adult; note
that prolonged high trough (>8 mg/mL) or peak (>30–35 mg/mL) levels are
associated with toxicity.
• Monitor S&S of ototoxicity (primarily involves the cochlear (auditory) branch;
high-frequency deafness usually appears first and can be detected only by
audiometer); indicators of declining renal function; respiratory tract infections and
other symptoms indicative of superinfections and notify physician should they
occur.
• Monitor for and report auditory symptoms (tinnitus, roaring noises, sensation of
fullness in ears, hearing loss) and vestibular disturbances (dizziness or vertigo,
nystagmus, ataxia).
• Monitor & report any changes in I&O, oliguria, hematuria, or cloudy urine.
Keeping patient well hydrated reduces risk of nephrotoxicity; consult physician
regarding optimum fluid intake.
Patient & Family Education
• Report immediately any changes in hearing or unexplained ringing/roaring noises

or dizziness, and problems with balance or coordination.
• Do not breast feed while taking this drug without consulting physician.
Common adverse effects in italic, life-threatening effects underlined: generic names in bold; classifications
in SMALL CAPS; Canadian drug name; Prototype drug
Copyright © 2006 Pearson Education, Inc. All Rights Reserved

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AMIKACIN SULFATE

Route & Dosage

Moderate to Severe Infections

PREPARE: Intermittent: • Add contents of 500 mg vial to 100 or 200 mL D5W, NS

INCOMPATIBILITIES Solution/additive: aminophylline, amphotericin B,

• Store at 15°–30° C (59°–86° F) unless otherwise directed.

Patient & Family Education

• Report immediately any changes in hearing or unexplained ringing/roaring noises

Copyright © 2006 Pearson Education, Inc. All Rights Reserved

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