Indications

serious Gram-negative infections resistant to gentamicin

Cautions
The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimize the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides . Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses. Aminoglycosides should be used with caution in those with conditions characterized by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable.

Contra-indications
Aminoglycosides may impair neuromuscular transmission and should not be given to patients with myasthenia gravis. Or in case of allergy to aminoglycoside.

Renal impairment
Excretion of aminoglycosides is principally via the kidney and accumulation occurs in renal impairment. Ototoxicity and nephrotoxicity occur commonly in patients with renal failure. If there is impairment of renal function, the interval between doses must be increased; if the renal impairment is severe, the dose itself should be reduced as well. Serum-aminoglycoside concentrations must be monitored in patients with renal impairment. Renal, auditory, and vestibular

function should also be monitored. A once-daily, high-dose regimen of an aminoglycoside should be avoided in patients with a creatinine clearance less than 20 mL/minute.

Pregnancy
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 (if given, serum-aminoglycoside concentration monitoring is essential).

Side-effects
The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibioticassociated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.

Dose
To avoid excessive dosage in obese patients, use ideal weight for height to calculate dose and monitor serum-amikacin concentration closely Multiple daily dose regimen, by intramuscular or by slow intravenous injection or by infusion, 15 mg/kg daily in 2 divided doses, increased to 22.5 mg/kg daily in 3 divided doses in severe infections; max. 1.5 g daily for up to 10 days (max. cumulative dose 15 g); child under 18 years.

Interaction
Amikacin has the following interaction information:

Amikacin belongs to Aminoglycosides and will have the following interactions:

increased risk of nephrotoxicity when aminoglycosides given with amphotericin increased risk of hypocalcaemia when aminoglycosides given with bisphosphonates increased risk of nephrotoxicity and ototoxicity when aminoglycosides given with capreomycin possible increased risk of nephrotoxicity when aminoglycosides given with cephalosporins increased risk of nephrotoxicity when aminoglycosides given with ciclosporin increased risk of otoxicity when aminoglycosides given with loop diuretics aminoglycosides enhance effects of non-depolarising muscle relaxants aminoglycosides antagonise effects of neostigmine aminoglycosides antagonise effects of pyridostigmine aminoglycosides enhance effects of suxamethonium Close monitoring required with concomitant administration of nephrotoxic drugs or cytotoxics

Amphotericin

Bisphosphonates

Capreomycin

Cephalosporin

Cyclosporine

Diuretics, Loop

Muscle Relaxants, non-depolarising Neostigmine

Pyridostigmine

Suxamethonium