This regimen can be completely empiric, where the dose is based on body weight, height, and creatinine clearance, or a regimen may be calculated based on one or more drug levels. Amikacin is a major drug used for the treatment of mycobacterium avium complex mac disease, but standard laboratory guidelines for susceptibility testing are not available. In multidrug regimens, including an intravenous aminoglycoside e. It acts by inhibiting protein synthesis of susceptible bacteria. Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. Mac macrolide yes sensitive no daily rifampin ethambutol other drug clofazimine moxifloxacin ciprofloxacin bedaquiline inh. Average dosage is 250 mg 2 to 4 times weekly for 6 months. Mycobacterium avium complex mac consists of two species. She was also on amikacin a couple of years ago at 650 mg daily for a little while. Urbancraig 1997 6 the urbancraig nomogram was developed with an option for q12h dosing, which is especially useful in younger patients with high aminoglycoside clearance who may have an inappropriately long interval of subtherapeutic drug levels. The study population consisted of patients with ntm. Daily versus thriceweekly dosing for treatment of mycobacterial diseases charles a. The usual adult dose is 500 mg given two to five times per week. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs.
Monitoring of amikacin levels is not required unless amikacin is given beyond 48 hours. Amikacin solution for parenteral administration is an established drug that has activity against a variety of ntm. The world health organization who guidelines state that all patients suspected of mdrtb should be given a group 2 injectable agent, usually an aminoglycoside. Plot serum concentration and time of level on nomogram below to determine interval wherever this point lies is the recommended dosing interval if the serum level is above the q48h interval, convert the patient to conventional dosing see below to use nomogram for amikacin, divide the actual serum level of amikacin in half. Aminoglycoside dosing and monitoring guidelines for adult patients at stony brook university hospital algorithm for initial aminoglycoside dosing. British thoracic society guidelines for the management of non. Serum concentrations of amikacin should be monitored when feasible to assure adequate levels and to avoid potentially toxic levels and prolonged peak concentrations above 35 micrograms per ml. It is also used for the treatment of multidrugresistant tuberculosis. Amikacin photo key points amikacin is an aminoglycoside antibiotic that inhibits bacterial growth in susceptible organisms by interfering with bacterial protein synthesis binds to 30s and 50s ribosomal subunits, resulting in a defective bacterial cell membrane exhibit concentrationdependent bacterial killing higher peak levels means more bacterial killing has activity against many. The efficacy, safety, and feasibility of inhaled amikacin. Aerosolized amikacin for treatment of pulmonary mycobacterium avium infections.
Amikacin level general information lab order codes. The primary mechanism of action of arikayce is the disruption and inhibition of protein synthesis in the target bacteria by binding to the 30s ribosomal subunit. The phone number is 18004456326, and press 0 to speak with a live person. Patients were treated with a variety of inhaled amikacin. Eightyseven patients with tuberculosis or non tuberculous mycobacterial infections were prospectively randomized by drug to receive 15 mgkg per day or 25 mgkg 3 times per week of intravenous streptomycin, kanamycin, or amikacin. Amikacin treatment for multidrug resistant tuberculosis. Amikacin is not absorbed orally and is given by either intramuscular or slow intravenous injection either once or twice daily or, in severe infections, three times daily. Amikacin liposome inhalation suspension is only indicated for patients with refractory mycobacterium avium complex mac lung disease who have limited or no alternate treatment options and have failed to achieve negative sputum cultures after at least 6 consecutive months of. Obtain amikacin trough and creatinine levels after 12. Multidrugresistant tuberculosis mdrtb is an increasing global problem. Cumulative sputum culture conversion rates after initiation of amikacin. An inhaled amikacin dose of 15 mgkgday was chosen with the following considerations.
Amikacin may also be used for purposes not listed in this medication guide. Amikacin is a semisynthetic aminoglycoside antibiotic used in the treatment of gramnegative infections resistant to gentamicin. Amikacin sulfate amikacin sulfate dose, indications. Mac is the atypical mycobacterium most commonly associated with human disease. Inhaled amikacin there was a stress on sterilization. Plot the measured gentamicin or amikacin levels against the corresponding time elapsed in hours from the start of. Arikayce is designed to deliver amikacin directly to the site of infection via inhalation. This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen. Pharmacotherapy approaches in nontuberculous mycobacteria. In one study, pharmacokinetic dosing with maintenance of trough levels below 1 mcgml significantly reduced the incidence of nephropathy with amikacin. Recently inhaled aerosolized amikacin has been used as a companion drug for patients with mac, especially for patients who have failed the standard.
Amikacin sulphate injection may be given intramuscularly or intravenously. Routine amikacin peak levels were performed 30 to 45 min after. Safety and effectiveness of lowdose amikacin in nontuberculous. Recommendations on prophylaxis and therapy for disseminated mycobacterium avium complex for adults and adolescents infected with human immunodeficiency virus. Following once daily inhalation of 590 mg arikayce in mycobacterium avium complex mac patients, sputum concentrations at 1 to 4 hours postinhalation were 1720, 884, and 0 mcgg at 1, 3, and 6 months, respectively. Amikacin trough levels of more than 10 mcgml have been associated with significant ototoxicity and nephrotoxicity.
Has only been studied for refractory mac lung disease. Urine should be examined for decreased specific gravity, increased. Useful for therapeutic drug monitoring lab testing sections. Mac is the atypical mycobacterium most commonly associated with. Hi all, after 7 weeks on amikacin via iv for mac, i have graduated to inhaled amikacin using a nebulizer.
It is used either by injection into a vein or muscle amikacin, like other aminoglycoside antibiotics, can cause hearing loss, balance. Trough levels should be taken immediately before the next dose. There is no published study of the side effects or effectiveness of amikacin when given in this manner. This includes joint infections, intraabdominal infections, meningitis, pneumonia, sepsis, and urinary tract infections. Amikacin sulphate is an aminoglycoside antibiotic with activity against a broad spectrum of gramnegative organisms such as pseudomonas species, escherichia coli, klebsiellaenterobacterserratia and salmonella species author. Levels should be taken from finger prick peripheral venepuncture and must not be taken from any lumen of any line through which amikacin. Recently inhaled aerosolized amikacin has been used as a companion drug for patients with mac, especially for patients who have failed the standard treatment. Serum concentrations of this drug should be monitored when feasible to assure adequate levels and to avoid potentially toxic levels and prolonged peak concentrations above 35 mcgml. Treatment of nontuberculous mycobacterial infections ntm.
Amikacin is an effective antibiotic for ntm infection. However, intravenous amikacin treatment is limited by its systemic route of administration and a lot of adverse events. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body weight tbw. Pdf safety and effectiveness of lowdose amikacin in. If you wish to use mayo pharmacy, you will need to call the pharmacy to set up a mail order account. Amikacin fda prescribing information, side effects and uses.
In pulmonary disease caused by mycobacterium avium complex mac, the most. Check when the assay was taken in relation to the amikacin dose high levels can result from being taken too soon after a dose i. Mycobacterium avium complex mac causes disseminated disease in up to 40% of patients with advanced human immunodeficiency virus hiv disease in the united states. High variability in amikacin concentrations were observed cv% 100%. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. These germs are very common in food, water, and soil. Amikacin is an alternative injectable agent but tends to be more toxic and is more expensive than streptomycin. Amikacin sulphate is an aminoglycoside antibiotic with. Exhibit concentrationdependent bacterial killing higher peak levels means more.
Mycobacterium avium complex mac is a group of bacteria related to tuberculosis. She has had mac for almost five years, and just started her amikacin infusion at 950 mg twice a week and she only weighs 95 lbs. Amikacin inhalation treatment could overcome these limitations and also could be effective for treatment of ntm pulmonary disease due to maintaining a high lung concentration. However, when taken for extended periods, these can cause nephrotoxicity, neurotoxicity and irreversible ototoxicity 1, 2. This study presents in vitro amikacin mics for 462 consecutive clinical isolates of the mac using a broth microdilution assay. Current systemic therapy for nontuberculous mycobacterial pulmonary infection is limited by poor clinical response rates, drug toxicities and side effects. The proportion of patients who had clinical symptoms, including, cough and sputum, declined after inhalation amk therapy. Streptomycin, kanamycin, and amikacin remain im portant drugs for. The addition of aerosolized amikacin to standard oral therapy for nontuberculous mycobacterial pulmonary infection may improve treatment efficacy without producing systemic toxicity. Urine should be examined for decreased specific gravity, increased excretion of proteins, and the presence of cells or casts.
Amikacin should not be physically premixed with other drugs, but should be administered separately according to the recommended dose and route. Its been a little less than a week and today i lost my. Rates of ntm lung infection which usually do not distinguish between. Aminoglycoside dosing and monitoring recommendations. The resultant level is then plotted on the nomogram, in which optimal dosing interval can be determined. Cp levels gentamicin and tobramycin amikacin dose 1 mgkg 1. Amikacin inhalation as salvage therapy for refractory. Aminoglycoside dosing and monitoring guidelines for adult. Amikacin works most effectively the higher the concentration of the drug exceeds the mic of the target organism. Desired trough levels for conventional dosing are less than 8 mcgml. Pdf aerosolized amikacin for treatment of pulmonary. Amikacin is an antibiotic used for a number of bacterial infections.
Check where the blood sample was taken from falsely high levels. Amikacin dosing, indications, interactions, adverse. Amikacin is a semisynthetic aminoglycoside antibiotic derived from kanamycin. Intravenous therapy for mac lung disease lung disease. Mycobacterium avium complex mac mycobacterium avium. The patients pretreatment bodyweight should be obtained for calculation of correct dosage. Amikacin is used to treat severe or serious bacterial infections. Amikacin is an aminoglycoside antibiotic that inhibits bacterial growth in. The desiredtarget trough levels for gentamicin and tobramycin is amikacin, its less than 4 mcgml or undetectable. Furthermore, this nomogram uses the highest dose of amikacin 20 mgkg versus 15 mgkg, which achieves a 33% higher amikacin peak.
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