Amikacin: Indications, Side Effects, Warnings, Precautions and Dosage

Bactericidal antibiotic of the group of aminoglycosides, used in the treatment of different bacterial infections.

Indications and uses

Injection of Amikacin sulfate is indicated in the short-term treatment of serious infections due to sensitive strains of Gram-negative bacteria, including species of Pseudomonas, Escherichia coli, Proteus species indole positive and indole, Providence species, Klebsiella-Enterobacter -Serratia, etc.

Clinical studies have shown that injection of Amikacin sulfate is effective in bacterial septicemia (including neonatal sepsis); in severe infections of the respiratory tract, bones and joints.

Also in the central nervous system (including meningitis) and skin and soft tissues; intra-abdominal infections (including peritonitis ); and in burns and postoperative infections (including posvascular surgery).

Clinical studies have shown that Amikacin is also effective in serious and recurrent urinary tract infections due to these organisms.

Aminoglycosides, including the injection of Amikacin sulfate, are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are not susceptible to antibiotics that have less potential toxicity.

Bacteriological studies should be conducted to identify causative organisms and their susceptibilities to Amikacin.

When it’s used?

Amikacin can be considered as initial therapy in suspected Gram-negative infections and therapy can be instituted before obtaining the results of the susceptibility tests.

Clinical trials demonstrated that Amikacin was effective in infections caused by gentamicin and / or tobramycin-resistant strains of Gram-negative organisms, particularly Proteus rettgeri, Providencia stuartii, Serratia marcescens and Pseudomonas aeruginosa.

Amikacin injection is used to treat the variety of bacterial infections of the lungs, skin, abdomen and blood caused by E.coli , Streptococci and Enterococci.

It is known that this drug causes serious kidney problems and hearing problems, especially in the elderly population. Do not take this medicine if you have a known allergy.

It is used in treatments for:

  • Intra-abdominal infection.
  • Pneumonia .
  • Bacteremia.
  • Bone and joint infections.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue with your normal diet.

What secondary effects can this medication cause?

Amikacin can cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • Nausea.
  • Vomiting
  • Diarrhea.
  • Headache.
  • Fever.

Warnings and precautions

Neurotoxicity, which manifests as vestibular and permanent bilateral auditory ototoxicity, can occur in patients with pre-existing renal damage and in patients with normal renal function treated at higher doses and / or for longer periods than recommended.

The risk of ototoxicity induced by aminoglycosides is greater in patients with kidney damage. High frequency deafness usually occurs first and can only be detected by audiometric testing.

There may be vertigo and it may be evidence of vestibular injury. Other manifestations of neurotoxicity may include numbness, tingling in the skin, muscle spasms, and seizures.

The risk of hearing loss due to aminoglycosides increases with the degree of exposure to high or high serum concentrations.

Patients who develop cochlear damage may have no symptoms during treatment to warn them about the development of toxicity of the eighth nerve, and irreversible partial or total bilateral deafness may occur after the medication has been discontinued.

The ototoxicity induced by aminoglycosides is usually irreversible.

Aminoglycosides are potentially nephrotoxic

The risk of nephrotoxicity is higher in patients with impaired renal function and in those receiving high doses or prolonged therapy.

Neuromuscular block and respiratory paralysis have been reported after parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or local treatment of empyema ), and after oral use of aminoglycosides .

The possibility of these phenomena should be considered if aminoglycosides are administered by any route, especially in patients receiving anesthetics, neuromuscular blockers such as tubocurarine, succinylcholine, decamethonium or in patients receiving massive blood transfusions with anticoagulated citrate.

If a blockage occurs, calcium salts can reverse these phenomena, but mechanical ventilation may be necessary.

Amikacin serum concentrations should be controlled when feasible to ensure adequate levels and avoid potentially toxic levels and prolonged peak concentrations above 35 micrograms per ml.

Serial audiograms should be obtained whenever possible in patients of sufficient age to be tested, particularly high-risk patients.

Evidence of ototoxicity (dizziness, vertigo, tinnitus, roaring in the ears and hearing loss) or nephrotoxicity requires the suspension of the medication or adjustment of the dose.

Dose

An alternate alternative guide for determining reduced doses at 12-hour intervals (for patients whose steady-state serum creatinine values ​​are known) is to divide the dose normally recommended by the patient’s serum creatinine.

The individual dose, the total daily dose and the total cumulative dose of Amikacin sulfate are identical to the dose recommended for intramuscular administration.

The solution for intravenous use is prepared by adding the contents of a 500 mg vial to 100 or 200 ml of sterile diluent, such as 0.9% sodium chloride injection or 5% dextrose injection or any other compatible solution.

The solution is administered to adults for a period of 30 to 60 minutes. The total daily dose should not exceed 15 mg / kg / day and can be divided into 2 or 3 equally divided doses at equally divided intervals.

In pediatric patients, the amount of fluid used will depend on the amount of Amikacin sulfate that is requested for the patient. It must be enough to infuse Amikacin for a period of 30 to 60 minutes. Babies should receive an infusion of 1 to 2 hours.

Amikacin should not be physically premixed with other medications, but should be administered separately according to the recommended dose and route.