exp date isn't null, but text field is
Prescribing and Monitoring Intravenous Amikacin in Adults
This guideline is adapted from the NHS Greater Glasgow and Clyde document, with permission.
Background
Amikacin is a protected aminoglycoside antibiotic and should only be prescribed on the advice of an infection specialist.
For glossary of terms see Glossary
A once daily regimen is preferred as this is safer for patients and more efficient without being any less effective than a multiple daily dose regimen.
Usual dose is 15mg/kg (maximum 1.5g) once a day with a maximum of 15g per course. There is a higher risk of ototoxicity with higher cumulative doses and longer treatment courses. The dose should be adjusted according to weight and degree of renal impairment.
|
Creatinine Clearance (CrCl) ml/min |
Amikacin Dose |
|
20 to 29 |
5·5mg/kg 24hrly |
|
30 to 49 |
6mg/kg 24hrly |
|
50 to 70 |
12mg/kg 24hrly |
|
Over 70 |
15mg/kg 24hrly |
Dose adjustment in obesity
If the patient is obese (greater than 120% of their IBW), use adjusted body weight, calculated as follows:
Ideal body weight (IBW) (kg):
Male IBW = 50 + (2.3 x (height in inches – 60))
Female IBW = 45 + (2.3 x (height in inches – 60))
Adjusted Bodyweight (AdjBW) (kg): AdjBW = IBW +0.4 (actual body weight (kg) – IBW)
Target Concentrations
|
|
If CrCl 50ml/min or above |
If CrCl less than 50 ml/min |
|
Peak (1 hour post dose) |
Greater than 35 mg/L |
15 to 30 mg/L |
|
Trough (pre-dose) |
Less than 2mg/L |
Less than 5 mg/L |
Prior to the second dose, take a trough level (immediately prior to dose) then a peak level (1 hour post dose) and then repeat these levels every 2 to 3 days thereafter.
Doses should continue to be administered whilst awaiting level as long as renal function is stable.
Samples are sent to via Raigmore Hospital Microbiology Laboratory to Bristol for analysis and are only processed Monday to Friday. Results should be available the following day but if sent on a Friday they would be back Monday at the earliest and later if a bank holiday.
Careful consideration therefore needs to be made if starting therapy on a Thursday or Friday as levels will not be available at the correct time to inform dosing. Microbiology should be involved and discussions had about the safety of treatment and whether or not an alternative therapy could be used in these situations.
UKMi Medicines Q&As How Should Antibiotics be dosed in Obesity? Updated 12th February 2018. Accessed 9/4/19 via https://www.sps.nhs.uk/articles/how-should-antibiotics-be-dosed-in-obesity
NHS Greater Glasgow and Clyde Adult Therapeutics Handbook Amikacin Dosing Guidance. Updated December 2018. Accessed 9/4/19 via http://handbook.ggcmedicines.org.uk/guidelines/infections/amikacin-dosing-guidelines-age-16-and-over
Last reviewed: 07 November 2019
Next review: 07 November 2022
Author(s): Antimicrobial Management Team
Version: 1
Approved By: TAM Subgroup of ADTC
Reviewer Name(s): Area Antimicrobial Pharmacist
Document Id: AMT101
