Amikacin

Aminoglycoside·Infectious Diseases - Other Antibiotics

Severe nosocomial Gram-negative sepsis (Pseudomonas, Acinetobacter) resistant to Gentamicin

AMINOGLYCOSIDEAmikinS4TGA

Max Dose

15 mg/kg/day

Half-life

2-3 h

Nephrotoxic

CRITICAL

Ototoxic

CRITICAL

Rapid Summary

Overview

The most robust, heavy-duty aminoglycoside. Exceptionally resistant to bacterial aminoglycoside-modifying enzymes. Reserved exclusively for highly resistant, life-threatening Gram-negative sepsis.

Maximum Dose

Max 15 mg/kg/day (strictly based on Ideal Body Weight).

Clinical Focus

Lethally nephrotoxic and permanently ototoxic (deafness) if trough levels do not fall to zero between doses.

Bottom Line

Amikacin is a potent aminoglycoside reserved for multi-resistant gram-negative infections, but has critical nephrotoxicity and irreversible ototoxicity requiring strict therapeutic drug monitoring.

Formulation & Access

Brand Names

Amikin

Parenteral

Ampoules/Vials (500 mg/2 mL) for IV or IM use.

Prescribing & PBS

Hospital supply. Strictly governed by Antimicrobial Stewardship.

Indications & Use

Primary

TGA

Severe nosocomial Gram-negative sepsis (Pseudomonas, Acinetobacter) resistant to Gentamicin. Empiric therapy for severe neutropenic fever.

Clinical Place

Last line of defense in the aminoglycoside class. Never used for simple infections.

Quick reference

Class & Role

Aminoglycoside — The most robust, heavy-duty aminoglycoside.

Route / Formulation

Ampoules/Vials (500 mg/2 mL) for IV or IM use. (Amikin)

Usual Dose & Max

IV 15 mg/kg OD (Infused over 30 mins). Max 15 mg/kg/day (strictly based on Ideal Body Weight).

Key Indication Doses

Severe Multi-Drug Resistant Sepsis: IV 15 mg/kg OD (Infused over 30 mins). Renal Impairment: Increase interval drastically. If eGFR 20-40, give dose every 48 hours. If eGFR < 20, dose ONLY by tracking serum levels (often every 72+ hours).

Best Uses

Amikacin is a potent aminoglycoside reserved for multi-resistant gram-negative infections, but has critical nephrotoxicity and irreversible ototoxicity requiring strict therapeutic drug monitoring.

Avoid / Cautions

Myasthenia Gravis, pre-existing hearing loss. Pregnancy Category D (Congenital deafness).

Key Risks

Renal: Acute tubular necrosis (AKI). The risk skyrockets if the drug 'trough' level stays high. Neurological: Irreversible vestibular and cochlear toxicity (permanent deafness and severe vertigo/balance destruction). Neuromuscular: Neuromuscular blockade (can exacerbate Myasthenia Gravis or surgical paralysis).

Key Interactions

Vancomycin, Loop Diuretics (Frusemide), Cisplatin. Synergistic, catastrophic nephrotoxicity and ototoxicity.

Monitoring

TDM (Therapeutic Drug Monitoring). Trough levels MUST be checked before the 2nd dose (Target < 5 mg/L). Daily U&E and eGFR. Question the conscious patient daily regarding tinnitus (ringing ears) or dizziness. Stop instantly if present.

Clinical Pearl

Aminoglycosides kill bacteria using the massive 'peak' concentration. They destroy the kidneys if the 'trough' concentration stays high. The kidney tubules need a 12-hour period of 'zero drug' in the blood to wash out and recover. This is why we use massive Once-Daily doses rather than smaller TDS doses.

Access

Amikin

Brand: Amikin

Amikacin

Aminoglycoside·Infectious Diseases - Other Antibiotics

Severe nosocomial Gram-negative sepsis (Pseudomonas, Acinetobacter) resistant to Gentamicin

AMINOGLYCOSIDEAmikinS4TGA

Max Dose

15 mg/kg/day

Half-life

2-3 h

Nephrotoxic

CRITICAL

Ototoxic

CRITICAL

Rapid Summary

Overview

The most robust, heavy-duty aminoglycoside. Exceptionally resistant to bacterial aminoglycoside-modifying enzymes. Reserved exclusively for highly resistant, life-threatening Gram-negative sepsis.

Maximum Dose

Max 15 mg/kg/day (strictly based on Ideal Body Weight).

Clinical Focus

Lethally nephrotoxic and permanently ototoxic (deafness) if trough levels do not fall to zero between doses.

Bottom Line

Amikacin is a potent aminoglycoside reserved for multi-resistant gram-negative infections, but has critical nephrotoxicity and irreversible ototoxicity requiring strict therapeutic drug monitoring.

Formulation & Access

Brand Names

Amikin

Parenteral

Ampoules/Vials (500 mg/2 mL) for IV or IM use.

Prescribing & PBS

Hospital supply. Strictly governed by Antimicrobial Stewardship.

Indications & Use

Primary

TGA

Severe nosocomial Gram-negative sepsis (Pseudomonas, Acinetobacter) resistant to Gentamicin. Empiric therapy for severe neutropenic fever.

Clinical Place

Last line of defense in the aminoglycoside class. Never used for simple infections.

Quick reference

Class & Role

Aminoglycoside — The most robust, heavy-duty aminoglycoside.

Route / Formulation

Ampoules/Vials (500 mg/2 mL) for IV or IM use. (Amikin)

Usual Dose & Max

IV 15 mg/kg OD (Infused over 30 mins). Max 15 mg/kg/day (strictly based on Ideal Body Weight).

Key Indication Doses

Best Uses

Amikacin is a potent aminoglycoside reserved for multi-resistant gram-negative infections, but has critical nephrotoxicity and irreversible ototoxicity requiring strict therapeutic drug monitoring.

Avoid / Cautions

Myasthenia Gravis, pre-existing hearing loss. Pregnancy Category D (Congenital deafness).

Key Risks

Key Interactions

Vancomycin, Loop Diuretics (Frusemide), Cisplatin. Synergistic, catastrophic nephrotoxicity and ototoxicity.

Monitoring

Clinical Pearl

Access

Amikin

Brand: Amikin