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Aminoglycoside Antibiotic

Amikacin

Brand names: Amikin

Adult dose

Dose: 15 mg/kg once daily (extended interval dosing preferred) or 7.5 mg/kg every 12 hours; adjust for renal function and therapeutic drug monitoring
Route: Intravenous or intramuscular injection
Frequency: Once daily (Hartford protocol) or twice daily; TDM-guided dosing

Clinical pearls

  • Reserved for Gram-negative infections resistant to gentamicin — particularly useful for extended-spectrum beta-lactamase (ESBL) and MDR-TB
  • Once-daily (extended interval) dosing exploits concentration-dependent killing and minimises toxicity
  • TDM essential: pre-dose (trough) <5 mg/L once daily; or peak/trough for BD dosing
  • Must check local sensitivity patterns (BSAC/EUCAST) before use
  • For MDR-TB: used as part of combination regimen under specialist guidance (NICE NG33; BSAC/WHO guidelines)
  • Intrathecal/intraventricular amikacin used for MDR Gram-negative meningitis (specialist)

Contraindications

  • Myasthenia gravis (may worsen neuromuscular blockade)
  • Severe renal impairment (dose adjust or avoid)
  • Prior aminoglycoside-related ototoxicity

Side effects

  • Nephrotoxicity (dose-related and cumulative) — especially with prolonged use
  • Ototoxicity (cochlear and vestibular) — may be irreversible
  • Neuromuscular blockade (rare)
  • Hypersensitivity reactions

Interactions

  • Loop diuretics (furosemide) — synergistic ototoxicity; avoid combination
  • Amphotericin B — additive nephrotoxicity
  • Vancomycin — additive nephrotoxicity
  • Cisplatin — additive ototoxicity and nephrotoxicity
  • Neuromuscular blocking agents — potentiation

Monitoring

  • TDM: pre-dose trough and/or post-dose peak at steady state
  • Serum creatinine and eGFR every 48–72 hours
  • Audiology assessment before and during prolonged courses
  • Vestibular function (balance, gait)
  • Duration of therapy (keep as short as possible)

Reference: BNF; BSAC Guidelines on aminoglycoside use (2011, updated); NICE NG33 (TB, 2016 updated); PHE/UKHSA AMR guidelines; https://bnf.nice.org.uk/drugs/amikacin/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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