- Amikacin, IV, 15 mg/kg daily.
- If BMI is >40 kg/m2 use ideal body weight* + 40% of the difference between ideal and actual body weight).
- In severe sepsis or septic shock, a loading dose of 25 mg/kg should be given (irrespective of renal function).
- If eGFR is 40–60 mL/minute, adjust maintenance dose to 15 mg/kg every 36 hours (check trough amikacin level and give the next dose when level <5 mg/L).
- Maximum daily dose 1.5 g, usually for a maximum of 10 days.
- Amikacin is potentially nephrotoxic and ototoxic – monitor creatinine three times per week and discontinue if vestibular or cochlear symptoms develop. Regular audiometry is essential with longer term use in patients with drug-resistant TB.
- Therapeutic drug monitoring: pre-dose amikacin trough levels after the third dose. Aim for a trough level of <5 mg/L.
- Normal renal function: do not wait for the amikacin level before giving the next dose. The level should be used to adjust the dose for the next day if applicable.
- Impaired renal function: wait for the amikacin level and give the next dose when level <5 mg/L.
- In obese patients or in patients with resistant Gram-negative bacteria also measure peak concentrations (0.5–1 hours after infusion). Aim for peak >30 mg/L (or ten times higher than the MIC for resistant organisms).
* ideal body weight calculator: https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight