Amikacin: Medical Uses, Action Mechanism, Dosage, Interactions, Contraindications and Side Effects

It is an antibiotic prescribed by a doctor, used to kill bacteria that cause certain infections in the body.

Like infections in the blood, lungs, abdomen, urinary tract, skin, joints, and bones.

A widespread infection for which this medication is prescribed is meningitis.

Amikacin belongs to a class of medications called aminoglycoside antibiotics.

These work by killing bacteria that cause infections.

This medicine is available in an injectable form to be administered directly into a vein (IV) or a muscle (IM) by a healthcare professional.

Common side effects of amikacin include nausea, vomiting, diarrhea, headache, and fever.


Amikacin acts by blocking the function of the ribosomal subunit of a bacterium, which makes it impossible to produce proteins.

Medical uses

The general use of amikacin is to treat severe infections with bacteria resistant to multiple drugs, for example, enterobacter, proteus, acinetobacter, pseudomonas, E. coli, Klebsiella, etc.

The only Gram-positive bacteria that amikacin strongly affects are staphylococcus and Nocardia.

Amikacin can also treat non-tuberculous microbial infections and tuberculosis (if caused by sensitive strains) when first-line drugs do not control the disease.

It is rarely used alone. It is often used in the following situations:

  • Bronchiectasis
  • Bone and joint infections.
  • All types of meningitis.
  • Granulocitopenia.
  • Intra-abdominal infections: as peritonitis.
  • As a complement to other medications: such as tazobactam, piperacillin, clindamycin, ampicillin, metronidazole or sulbactam.
  • Infection by mycobacteria: included as a second-line agent for active tuberculosis.
  • Rhodococcus equi: which causes an infection similar to tuberculosis.
  • Respiratory tract infections: even as a complement of beta-lactams or carbapenem for hospital-acquired pneumonia.
  • Septicemia: including neonatal, as a complement of beta-lactams or carbapenem.
  • Infections of the skin and the site of sutures.
  • Urinary tract infections: caused by bacteria resistant to less toxic drugs.

Amikacin can be combined with a beta-lactam antibiotic for empirical therapy in people with neutropenia and fever.

Liposomal amikacin for inhalation is currently in late-phase clinical trials to treat respiratory diseases, such as cystic fibrosis, Pseudomonas aeruginosa, nontuberculous mycobacterial infections, and bronchiectasis.

Mechanism of action

Amikacin binds irreversibly to the 16S RNA ribosome and the RNA binding protein S12 of the 30S subunit of the prokaryotic ribosome. It inhibits protein synthesis by modifying the ribosome shape so that it can not read the codons of the mRNA correctly.

It also interferes with the region that interacts with the oscillation base of the tRNA anticodon.

It works in a concentration-dependent manner and has a better action in an alkaline environment.

Amikacin-sensitive bacteria, in regular doses, respond within 24-48 hours.

Dosage and duration

Amikacin can be administered once or twice a day and is usually administered intravenously or intramuscularly, although it can be helped by nebulization.

There is no oral form available since amikacin is not absorbed orally.

In people with renal impairment, the dose should be adjusted according to creatinine clearance, usually by reducing the frequency of dosing.

In people with a central nervous system (CNS) infection such as meningitis, amikacin can be given intrathecally (by direct injection into the spine) or intraventricularly (by injection into the ventricles of the brain).

Amikacin should be used in smaller doses because the elderly usually suffer from age-related decreases in renal function and in children whose kidneys are not yet fully developed.

Amikacin is considered to have a chance to harm the fetus during pregnancy.

About 16% of amikacin crosses the placenta; while the average life of amikacin in the mother is 2 hours, it is 3.7 hours in the fetus.

Although it is known to cross the placenta, amikacin is only partially secreted in breast milk.

In general, amikacin should be avoided in babies.

Babies also tend to have a greater volume of distribution due to their higher concentration of extracellular fluid, where the aminoglycosides reside.

The elderly tend to retain amikacin for longer in their system, while the average amikacin elimination of a 20-year-old is 6 L / h, and in an 80-year-old person, it is 3 L / h.

In people with cystic fibrosis, the elimination capacity is more significant.

In people with muscle disorders such as myasthenia gravis or Parkinson’s disease, the paralyzing effect of amikacin on neuromuscular junctions can worsen muscle weakness.


Interactions with other medications can change the functioning of amikacin or increase the risk of severe side effects.

This medicine should not be swallowed or if you are already taking it, increase the dose without first talking to your doctor.

Tell your doctor about all the medicines you take, including naturopaths. These include:

  • Aciclovir (Zovirax, Sitavig).
  • Certain cephalosporin antibiotics: such as cefazolin (Ancef, Kefzol), cefixime (Suprax), or cephalexin (Keflex).
  • Anfotericina (Abelcet, Ambisome, Amphotec).
  • Cisplatino (Platinol, Platinol-AQ).
  • Bacitracin.
  • Capreomicina (Capastat).
  • Colistin (Coly-Mycin S).
  • Ciclosporina (Gengraf, Neoral, Restasis, Sandimmune).
  • Diuretics such as furosemide (Lasix), ethacrynic acid (Edecrin), torsemide (Demadex) or bumetanide .
  • Other aminoglycoside antibiotics: such as gentamicin, kanamycin, neomycin(Neo-Fradin), paromomycin, streptomycin, or tobramycin.
  • Other antibiotics: such as amoxicillin (Amoxil, Larotid, Moxatag, Augmentin, Prevpac), ampicillin, or penicillin.
  • Polimixina B.
  • Meclizine (Bonine).
  • Vancomycin (Lanoxin).
  • Dimenhidrinato (Dramamina).
  • Non-steroidal anti-inflammatory drugs: such as indomethacin (Indocin, Tivorbex).

This list does not reflect all medications that interact with amikacin.

If you have any questions or questions, ask your doctor.


Amikacin should be avoided in those sensitive to aminoglycoside since they are cross-allergic (i.e., an allergy to an aminoglycoside also confers hypersensitivity to other aminoglycosides).

It should also be avoided in those sensitive to sulfite (most commonly seen among people with asthma ) since most amikacin usually comes with sodium metabisulfite, which can cause an allergic reaction.

Amikacin should not be used with, just before, or after another medication that may cause neurotoxicity, ototoxicity or nephrotoxicity.

These drugs include antibiotics (capreomycin, colistin, bacitracin, polymyxin, and vancomycin); cisplatin (used for chemotherapy); antifungal amphotericin B and antiviral acyclovir.

The likelihood of effects such as muscle weakness and paralysis may appear if amikacin is ingested along with neuromuscular blockers, so it is important not to mix them.

Side effects

Along with its necessary effects, amikacin can cause some unwanted effects.

It should be noted that most of the side effects mentioned below are very strangely presented; even the most common have no tendency to occur.

However, consult a health professional immediately if you experience any of the following side effects while taking amikacin:

  • Agitation.
  • Black, tarry stools.
  • Bloody or cloudy urine.
  • Bluish lips or skin
  • Blurry vision.
  • Burning, tingling, itching, or tingling
  • Chest pain.
  • Cold.
  • Coma.
  • Confusion.
  • To.
  • The amount of urine decreased.
  • Decrease in urine production.
  • Depression.
  • Difficulty breathing.
  • Difficulty with movement.
  • Dizziness.
  • Fainting or stunning. When suddenly rising from a lying or sitting position.
  • Drowsiness.
  • Dry mouth.
  • The sensation of covered ears.
  • Hearing loss.
  • Irritability.
  • Fever.
  • Lethargy.
  • Loss of balance
  • Change in hearing.
  • Muscle pain or stiffness
  • Muscle spasms.
  • Nausea.
  • Headache.
  • Pain in the joints.
  • Pain in the lumbar or lateral area.
  • Painful or difficulty urinating.
  • Pale skin.
  • Rapid weight gain
  • Ringing in the ears.
  • Convulsions
  • Tremors in the legs, arms, hands, or feet.
  • Difficulty breathing.
  • Sore throat.
  • Sores, ulcers, or white spots on the lips or mouth.
  • Stupor.
  • Perspiration.
  • Swelling of the face, ankles, or hands.
  • Swollen glands
  • However.
  • Tremor or trembling of the hands or feet.
  • Problems with hearing.
  • Difficulty breathing with effort.
  • Unusual bruising and bleeding.
  • Tiredness or weakness

Some side effects of amikacin can occur and usually do not require medical attention.

The side effects usually disappear throughout the treatment when your body adapts to the medicine.


Contact your doctor or seek emergency medical attention if an overdose is suspected.

An overdose of the medication can cause kidney damage or hearing loss, dizziness, numbness, tingling in the skin, muscle spasms, or seizures (signs of nerve damage).


Before taking amikacin, tell your doctor or pharmacist if you are allergic to it or other aminoglycoside antibiotics (such as gentamicin or tobramycin) or any other allergies.

Amikacin can cause live bacterial vaccines (such as the typhoid vaccine) not to work as well.

It is advisable not to get vaccinated while using this medication unless your doctor tells you to.

Older adults may be more sensitive to the effects of this medication, especially those related to kidney damage.

Tell your doctor if you plan to become pregnant or if you are pregnant.

The FDA classifies medications according to safety for use during pregnancy.

Five categories, A, B, C, D, and X, classify possible risks to the fetus when a medication is taken during pregnancy.

Amikacin belongs to category D. It has been shown that amikacin in pregnant women causes some babies to be born with problems.

It is essential to notify your doctor if you are nursing since it is known that amikacin crosses breast milk.

Because many medications can pass into breast milk and the possibility of severe adverse reactions in infants, the decision should be made to stop breastfeeding or stop using this medication.