Formulary
Amikacin: Indications, Dosing, Side Effects and Interactions
Amikacin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Amikacin: Indications, Dosing, Side Effects and Interactions
Amikacin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Serious Gram-negative infections resistant to gentamicin (multiple daily dose regimen)**
- **Adult** (By Intramuscular Injection, Or By Slow Intravenous Injection, Or By Intravenous Infusion): 7.5 mg/kg every 12 hours (max. per dose 750 mg) for up to 10 days, alternatively 7.5 mg/kg every 8 hours (max. per dose 500 mg) for up to 10 days, increased frequency to be used in severe infections; maximum 15 g per course.
**Serious Gram-negative infections resistant to gentamicin (once daily dose regimen)**
- **Adult** (By Intravenous Infusion): Initially 15 mg/kg once daily (max. per dose 1.5 g), dose to be adjusted according to serum-amikacin concentration; maximum 15 g per course.
**Acute prostatitis (once daily dose regimen)**
- **Adult** (By Intravenous Infusion, Or By Slow Intravenous Injection): Initially 15 mg/kg once daily (max. per dose 1.5 g), dose to be adjusted according to serum-amikacin concentration; maximum 15 g per course.
**Acute pyelonephritis (once daily dose regimen),Urinary tract infection (catheter-associated, once daily dose regimen)**
- **Adult** (By Intravenous Infusion, Or By Slow Intravenous Injection): Initially 15 mg/kg once daily (max. per dose 1.5 g), dose to be adjusted according to serum-amikacin concentration; maximum 15 g per course.
**Non-tuberculous mycobacterial lung infections caused byMycobacterium aviumcomplex in patients without cystic fibrosis [in combination with other drugs] (specialist use only)**
- **Adult** (By Inhalation Of Nebulised Suspension): Non-tuberculous mycobacterial lung infections caused by Mycobacterium avium complex in patients without cystic fibrosis [in combination with other drugs] (specialist use only) 590 mg once daily for 12 months after negative sputum cultures, or for up to 6 months if negative sputum cultures not confirmed; treatment should not exceed 18 months.
**Serious Gram-negative infections resistant to gentamicin (multiple daily dose regimen) for amikacin**
- **Child 1 month-11 years** (By slow intravenous injection): 7.5 mg/kg every 12 hours.
- **Child 12-17 years** (By slow intravenous injection): 7.5 mg/kg every 12 hours (max. per dose 750 mg) for up to 10 days, alternatively 7.5 mg/kg every 8 hours (max. per dose 500 mg) for up to 10 days, increased frequency to be used in severe infection; maximum 15 g per course.
**Serious Gram-negative infections resistant to gentamicin (once daily dose regimen) for amikacin**
- **Child 1 month-11 years** (By intravenous infusion, or by slow intravenous injection): Initially 15 mg/kg once daily, not to be used for endocarditis or meningitis, dose to be adjusted according to serum-amikacin concentration.
- **Child 12-17 years** (By intravenous infusion, or by slow intravenous injection): Initially 15 mg/kg once daily (max. per dose 1.5 g), not to be used for endocarditis or meningitis, dose to be adjusted according to serum-amikacin concentration.
**Neonatal sepsis (extended interval dose regimen) for amikacin**
- **Neonate** (By slow intravenous injection, or by intravenous infusion): 15 mg/kg every 24 hours.
**Neonatal sepsis (multiple daily dose regimen) for amikacin**
- **Neonate** (By intramuscular injection, or by slow intravenous injection, or by intravenous infusion): Loading dose 10 mg/kg for 1 dose, then 7.5 mg/kg every 12 hours.
**Pulmonary infection with Pseudomonas aeruginosa in cystic fibrosis for amikacin**
- **Child** (By intravenous infusion): Initially 30 mg/kg once daily (max. per dose 1.5 g), dose to be adjusted according to serum-amikacin concentration.
- **Child** (By slow intravenous injection, or by intravenous infusion): Initially 10 mg/kg every 8 hours (max. per dose 500 mg), dose to be adjusted according to serum-amikacin concentration.
**Acute pyelonephritis (once daily dose regimen), Urinary tract infection (catheter-associated, once daily dose regimen) for amikacin**
- **Child 3 months-11 years** (By intravenous infusion, or by slow intravenous injection): Initially 15 mg/kg once daily, dose to be adjusted according to serum-amikacin concentration.
- **Child 12-15 years** (By intravenous infusion, or by slow intravenous injection): Initially 15 mg/kg once daily (max. per dose 1.5 g), dose to be adjusted according to serum-amikacin concentration.
- **Child 16-17 years** (By intravenous infusion, or by slow intravenous injection): Initially 15 mg/kg once daily (max. per dose 1.5 g), dose to be adjusted according to serum-amikacin concentration; maximum 15 g per course.
Cautions
For all aminoglycosides (by injection) Auditory disorder; care must be taken with dosage (the main side-effects of the aminoglycosides are dose-related); conditions characterised by muscular weakness (aminoglycosides may impair neuromuscular transmission); if possible, dehydration should be corrected before starting an aminoglycoside; vestibular disorder; whenever possible, parenteral treatment should not exceed 7 days Cautions For amikacin When used by inhalation History of reactive airway disease, asthma, or bronchospasm (pre-treat with a short-acting bronchodilator); known or suspected neuromuscular disorders; underlying pulmonary disease (discontinue if signs of exacerbation occur)
Contraindications
For all aminoglycosides (by injection) Myasthenia gravis (aminoglycosides may impair neuromuscular transmission) Contra-indications For amikacin When used by inhalation Myasthenia gravis (aminoglycosides may impair neuromuscular transmission)
Side effects
For all aminoglycosides (by injection) Common or very common Aphonia; appetite decreased; bronchospasm; chest discomfort; cough; diarrhoea; dizziness; dysphonia; fever; haemoptysis; headache; hearing impairment; increased risk of infection; nausea; oropharyngeal pain; renal impairment; skin reactions; taste altered; tinnitus; vomiting Rare or very rare Anaemia; azotaemia; eosinophilia; hypomagnesaemia; paraesthesia Frequency not known Confusion; lethargy; leucopenia; muscle weakness; nephrotoxicity; peripheral neuropathy; thrombocytopenia; vertigo Side-effects, further information Ototoxicity and nephrotoxicity are important side-effects to consider with aminoglycoside therapy. Nephrotoxicity occurs most commonly in patients with renal impairment, who may require reduced doses; monitoring is particularly important in the elderly. Side-effects For amikacin General side-effects: Common or very common Arthralgia; balance impaired Specific side-effects: Common or very common When used by inhalation Dry mouth; dyspnoea; fatigue; interstitial lung disease; myalgia; respiratory disorders; sputum increased; throat irritation; weight decreased Uncommon When used by inhalation Anxiety Rare or very rare With parenteral use Albuminuria; hypotension; muscle twitching; tremor Frequency not known When used by inhalation Hypersensitivity; neuromuscular disorders; ototoxicity With parenteral use Apnoea; neuromuscular blockade; paralysis Side-effects, further information Since systemic absorption can follow inhaled use, also consider the side-effects of systemic aminoglycosides.
Interactions
**Severe interactions:**
- Aminoglycoside antibiotics (e.g.
**Other interactions (1):**
- Also, use with other drugs that are not given for the treatment of tuberculosis but have ototoxic or nephrotoxic potential (e.g.
Pregnancy
For all aminoglycosides (by injection) There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin. The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential. Monitoring in pregnancy If given during pregnancy, serum-aminoglycoside concentration monitoring is essential. Pregnancy For Arikayce liposomal nebuliser dispersion When used by inhalation: Avoid-no information available. M
Breast feeding
For Arikayce liposomal nebuliser dispersion When used by inhalation: Avoid-no information available. M
Renal impairment
For all aminoglycosides (by injection) Aminoglycosides are primarily renally excreted and accumulation can occur in renal impairment (increased risk of ototoxicity and nephrotoxicity)-serum-aminoglycoside concentrations must be frequently monitored in patients with renal impairment. M Dose adjustments Reduce dose and/or increase the dose interval according to impairment (consult product literature). M Renal impairment For amikacin When used by inhalation: Avoid in severe impairment (no information available). M
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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