1. 15mg/kg IV as a daily dose every 24 hours, given as an infusion over 30 minutes ^{4 , 6, 7, 8}

Indications

1. Suspected or proven late-onset neonatal sepsis.

Contraindications and Precautions

1. Hypersensitivity to amikacin/other aminoglycosides.
2. Extreme caution in neonates with renal dysfunction.
3. Caution in concurrent therapy with cephalosporins, potent diuretics such as furosemide and neuromuscular blocking agents.
4. Concurrent administration with other ototoxic and/or nephrotoxic drugs.
5. Patients with muscular disorders eg. myasthenia gravis. The curare-like effect at the neuromuscular junction, which may occur with aminoglycosides, can aggravate the muscle weakness in these conditions.¹

Clinical Pharmacology ^{1, 4} 

Amikacin is a semi-synthetic aminoglycoside antibiotic which is thought to distribute mainly into extracellular fluid in neonates. It is 11% protein bound (adults) and excreted unchanged predominantly by glomerular filtration in the kidneys. The half life is 7-14 hours in babies (postmenstrual age < 30 weeks) and 4-7 hours at a postmenstrual age of 40 weeks.

Amikacin has in vitro activity against gram-negative organisms (including Pseudomonas spp., Proteus spp., Klebsiella, Enterobacter, Serratia spp., Citrobacter, E.Coli.) and gram-positive Staphylococcus aureus including the methicillin-resistant strains. When indicated, concomitant therapy with a penicillin type drug may be necessary to cover for gram-positive organisms such as Streptococci.

Possible Adverse Effects ^{1, 5}

1. Ototoxicity, both vestibular and auditory, is seen mainly with co-existing renal impairment, high doses of amikacin and/or prolonged therapy. The risk is increased with dehydration and previous/current exposure to another ototoxic agent. Amikacin affects auditory function to a greater extent than gentamicin. Aminoglycoside induced ototoxicity is usually irreversible.
2. Renal impairment, azotemia, oliguria.
3. Hepatotoxicity.
4. Laboratory test interference may occur with: bilirubin (↑), Na⁺ (↓), K⁺ (↓), Platelets (↓), and others (see data sheet).

Drug Interactions ^{1, 2, 3}

Special Considerations

1. Monitor: renal function, hydration.
   • Measure serum creatinine, Magnesium and Calcium levels with Amikacin trough levels in cases of prolonged (longer than 7 days) Amikacin therapy. elevation in serum creatinine level may be a more sensitive indicator of renal injury.
   • Check trough levels:
     • prior to the 2nd dose, for infants <34 weeks corrected gestational age and then every 3-5 days as required.
     • prior to the 3rd dose for infants >34 weeks corrected gestational age and then every 3-5 days as required.
   • Serum levels ⁴:
     • Trough <3mg/L
     • Peak 20-30mg/L (1 hour following the commencement of the infusion; 30 minutes after the infusion ceases). DO NOT routinely check peak levels
2. Adjust dosing intervals to 36-48 hourly if trough levels are above the acceptable limits or in infants with suspected/proven renal impairment, or reduced clearance due to extreme prematurity and/or dose intervals in infants with suspected/proven renal impairment, or reduced clearance due to extreme immaturity.
3. If significant renal impairment, or if there are other risk factors (e.g. multiple nephrotoxic or ototoxic medications used concurrently or a prolonged treatment course) consider stopping amikacin.