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Home , Amikacin

Anti-TB drug information sheets

Amikacin (Amk) :

Activity against TB, Bactericidal: Inhibits synthesis. Cross-resistance with mechanism of action, kanamycin is considered complete and some data suggesting and metabolism cross-resistance with can occur. Primarily excreted unchanged through the by glomerular filtration.

Dose Adults: 15 mg/kg/day in a single daily dose, 5–7 days per week (maximum dose is generally 1 gram). 15 mg/kg/dose, 3 times per week can be used after culture conversion is documented after initial period of daily administration. >59 years of age: 10 mg/kg/dose (max 750 mg) 5–7 times per week or 2–3 times per week after initial period. Alternatively, 15 mg/kg/dose 3 times per week. Children: 15–30 mg/kg/day (max 1 gram) 5–7 days per week. 15–30 mg/kg/day (max 1 gram) 3 days per week after initial period daily.

Preparation and Given intravenous (IV) or intramuscular (IM). Not absorbed orally. administration For IV solution, mix with D5W or other solutions (in at least 100 ml of fluid for adults or 5 mg/ml for children). IM absorption can be delayed if same site is used consistently. For IV administration, infuse over 30–60 minutes for adults; 1–2 hours for children; IM absorption is complete within 4 hours.

Storage Solution is stable at room temperature (15–25 °C); diluted solution is stable at room temperature for at least 3 weeks or in the refrigerator for at least 60 days.

CSF penetration Variable penetration; appears to penetrate inflammed meninges better.

Special circumstances Use in /breastfeeding: Generally avoided during pregnancy due to congenital deafness seen with and kanamycin. Can be used while breastfeeding. Use in renal disease: Use with caution. Concentrations should be monitored for patients with impaired renal function. Interval adjustment is recommended for renal impairment or dialysis. 12–15 mg/kg/dose after dialysis 2–3 times weekly (not daily). The drug is variably cleared by haemodialysis. Use in hepatic disease: Drug concentrations not affected by hepatic disease (except a larger volume of distribution for alcoholic cirrhotic patients with ascites). Presumed to be safe in severe liver disease; however, use with caution in patients with severe liver disease as it may progress rapidly to hepatorenal syndrome.

253 COMPANION HANDBOOK TO THE WHO GUIDELINES FOR THE PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT

Adverse reactions Common: Local pain with intramuscular injections. Proteinuria. Occasional: , (), vestibular toxicity (, ataxia, dizziness). All increases with advanced age and prolonged use. Electrolyte abnormalities, including hypokalaemia, hypocalcaemia, and hypomagnesaemia. Rare: Neuropathy, .

Contraindications Pregnancy — relative contraindication (congenital deafness). Hypersensitivity to . Caution with renal, hepatic, vestibular or auditory impairment

Drug interactions Co-administration of loop diuretics (furosemide) and aminoglycoside carries an increased risk of ototoxicity.

Monitoring Monitor renal function by documenting at least monthly (more frequently if renal or hepatic impairment); document creatinine clearance if there is baseline renal impairment or any concerns; document baseline and monthly audiology exam; follow monthly electrolytes, magnesium and calcium. Question patient regularly about vestibular complaints and perform serial vestibular exams. Document peak and trough concentrations at baseline if there is any question about renal function. Some experts monitor aminoglycoside concentrations routinely, regardless of renal function. Monitor concentrations serially for patients with impaired renal function.

Patient instructions Instruct patients to inform their health care provider right away if and alerting symptoms any of the following occurs: • Problems with hearing, dizziness or balance • Rash or swelling of your face • Trouble breathing • Decreased urination • Swelling, pain or redness at your IV site • Muscle twitching or weakness.

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