Bactericidal aminoglycoside (broad spectrum, incl. Pseudomonas)
Amikacin is an aminoglycoside antibiotic given by injection, used to treat serious infections caused by Gram-negative bacteria (including Pseudomonas, E. coli and Klebsiella), mainly in hospital. It is effective but can damage the kidneys (nephrotoxicity) and the inner ear (ototoxicity), so close monitoring and blood level monitoring are required.
Also known as: Amikin
Combining Amikacin with Vancomycin increases the risk of nephrotoxicity and ototoxicity, with an additive effect on the kidney and the inner ear.
Vancomycin ("systemic exposure may result in acute kidney injury") and amikacin (an aminoglycoside with "ototoxicity and nephrotoxicity associated with their use", ototoxicity being "usually irreversible" and "greater in patients with renal damage") have overlapping toxicity that adds up in combination. The risk is particularly high in critically ill patients, pre-existing renal impairment, hypovolaemia, sepsis or prolonged therapy, and nephrotoxicity "may not become apparent until the first few days after cessation of therapy" (amikacin label). Monitor creatinine daily, vancomycin and amikacin levels, and otological symptoms (tinnitus, vertigo, hearing loss); adjust doses to creatinine clearance and reassess the need to keep both after 5–7 days.
Vancomycin + amikacin: additive renal and cochlear/vestibular toxicity. Monitor renal function, levels and hearing; adjust to creatinine clearance.
Vancomycin and Amikacin (aminoglycoside) are nephrotoxic and ototoxic; combined use adds renal and cochlear/vestibular toxicity, particularly with prior renal impairment or prolonged therapy.
Monitor renal function, serum levels of both drugs and signs of ototoxicity.
Worsening renal function, oliguria or auditory signs require prompt discontinuation and evaluation.
Avoid the combination; if needed, use the shortest course, hydrate and adjust doses to renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890 ; approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Amikacin with Furosemide increases the risk of ototoxicity and nephrotoxicity through an additive effect on the inner ear and the kidney.
Both amikacin (aminoglycoside) and furosemide (loop diuretic) are ototoxic, and the combination potentiates the risk of auditory and vestibular damage, especially in patients with renal impairment, high doses or rapid intravenous administration. The amikacin label recommends avoiding concomitant use with potent diuretics (ethacrynic acid or furosemide), because diuretics can cause ototoxicity on their own and, given intravenously, can increase aminoglycoside toxicity by altering its serum and tissue concentrations; the furosemide label states it may increase the ototoxic potential of aminoglycosides, especially with impaired renal function, and advises against the combination except in life-threatening situations. If unavoidable, monitor renal function, audiometry and signs of vestibulotoxicity (dizziness, nystagmus, tinnitus).
Amikacin + furosemide: additive ototoxicity (auditory and vestibular). Avoid the combination, except in life-threatening situations.
Amikacin (aminoglycoside) and Furosemide (loop diuretic) are both ototoxic and nephrotoxic; co-administration potentiates vestibular/cochlear and renal toxicity, especially with renal impairment or dehydration.
Monitor renal function, urine output, electrolytes and ototoxic signs; serum amikacin levels during prolonged regimens.
Tinnitus, vertigo, hearing loss or worsening renal function require prompt discontinuation and evaluation.
Avoid the combination; if needed, minimize duration, ensure adequate hydration and adjust the amikacin dose to renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890 ; approved Furosemide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7cdcd001-ab4b-4210-a455-2e17a7bc4972 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Amikacin is given intravenously or intramuscularly; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
No relevant pharmacokinetic interaction, but alcohol can worsen ototoxicity/vestibular symptoms and dehydration.
Moderate alcohol intake during treatment.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Amikacin is eliminated renally; renal impairment increases the risk of nephrotoxicity and ototoxicity.
Adjust the dose and interval based on renal function and monitor serum levels and renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Aminoglycosides are ototoxic; patients with pre-existing hearing loss or vestibular disease are at increased risk.
Monitor for ototoxic symptoms (tinnitus, vertigo, hearing loss) and consider audiometry in prolonged treatment.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Aminoglycosides can cause fetal ototoxicity; use only if the benefit outweighs the risk.
Use only in severe infections when there is no alternative (e.g., multidrug-resistant tuberculosis).
Present in breast milk in small amounts; the ototoxicity risk to the infant is considered low, but use with caution.
No specific contraception required.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Bactericidal broad-spectrum aminoglycoside directed mainly at Gram-negatives (Pseudomonas, Escherichia coli, Klebsiella-Enterobacter-Serratia, Proteus, Acinetobacter), also active against staphylococci and many gentamicin- and tobramycin-resistant strains. Indicated for short-term treatment of serious infections (septicaemia, respiratory tract, bone and joints, CNS including meningitis, skin and soft tissue, intra-abdominal, burns, and complicated/recurrent urinary tract infections). The potential for ototoxicity, nephrotoxicity and neuromuscular blockade limits its use.
Binds to the prokaryotic ribosome, inhibiting protein synthesis in susceptible bacteria; bactericidal in vitro against Gram-positive and Gram-negative bacteria. Resists degradation by several aminoglycoside-inactivating enzymes that affect gentamicin, tobramycin and kanamycin. Combination with a beta-lactam is synergistic against many clinically significant Gram-negatives.
Rapidly absorbed after intramuscular administration: mean peak serum concentrations of about 12, 16 and 21 mcg/mL 1 hour after 250, 375 and 500 mg doses (3.7, 5 and 7.5 mg/kg); after a 500 mg IV infusion over 30 minutes the mean peak is 38 mcg/mL at the end of the infusion. Mean volume of distribution 24 L (28% of body weight); protein binding 0 to 11% (ultrafiltration). Remains mainly in the extracellular space.
Excreted essentially by glomerular filtration with no relevant metabolism: with normal renal function about 91.9% of an intramuscular dose is excreted unchanged in urine in the first 8 hours and 98.2% within 24 hours (84% in 9 h and about 94% within 24 h after IV infusion). In renal impairment excretion is much slower, prolonging half-life — adjust the dose.
Mean serum half-life slightly over 2 hours with normal renal function; mean serum clearance about 100 mL/min (renal clearance 94 mL/min). Prolonged in renal impairment (correlated inversely with postnatal age in neonates) and in heart failure. Therapeutic levels are found in bone, heart, gallbladder and lung, in addition to urine, bile and sputum.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
