Amikacin

(For additional information see "Amikacin: Pediatric drug information") General dosing, severe, susceptible infections: Infants, Children, and Adolescents: IM, IV: 15 to 22.5 mg/kg/day divided every 8 hours or 15 to 20 mg/kg/dose every 24 hours (Red Book [AAP 2015]) Dosage should be based on an estimate of ideal body weight. In morbidly obese children and adolescents, dosage requirement may best be estimated using a dosing weight of IBW + 0.4 (TBW - IBW). Initial dosing recommendation presented; dosage should be individualized based upon serum concentration monitoring. Initial and periodic plasma drug concentrations (eg, peak and trough with conventional dosing, post dose level at a prespecified time with extended-interval dosing) should be determined, particularly in critically ill patients with serious infections or in disease states known to significantly alter aminoglycoside pharmacokinetics (eg, cystic fibrosis, burns, or major surgery). Indication-specific dosing: CNS infections (off-label dose): Meningitis (Tunkel 2004): Infants and Children: IV: 20 to 30 mg/kg/day divided every 8 hours Adolescents: IV: 15 mg/kg/day divided every 8 hours VP-shunt infection, ventriculitis: Limited data available: Intraventricular/intrathecal (use a preservative free preparation): Infants, Children, and Adolescents: 5 to 50 mg/day; usual dose: 30 mg/day Cystic fibrosis, pulmonary infection (systemic use) (off-label use): Infants, Children, and Adolescents: Traditional dosing: IV, IM: 10 mg/kg/dose every 8 hours (Wallace 1993) Extended-interval dosing: IV: 30 mg/kg/dose every 24 hours (Flume 2009); Note: The CF Foundation recommends extended-interval dosing as preferred over traditional dosing. Cystic fibrosis, pulmonary infection (inhalational use; off-label use/route): Inhalation for nebulization: Adolescents ≥14 years: Monotherapy: Refer to adult dosing Children ≥3 years and Adolescents: Adjunctive therapy: Refer to adult dosing Endocarditis, treatment (off-label dose): Children and Adolescents: IV: 15 mg/kg/day divided every 8 to 12 hours; use in combination with other antibiotics dependent upon organism and source of infection (ie, valve-type) (AHA [Baltimore 2015]) Intra-abdominal infection, complicated (off-label dose): Infants, Children and Adolescents: IV: 15 to 22.5 mg/kg/day divided every 8 to 24 hours (Solomkin 2010) Mycobacterium, avium complex infection (MAC) (off-label use): HIV-exposed/-positive: Infants and Children: IV: 15 to 30 mg/kg/day divided every 12 to 24 hours as part of a multiple drug regimen; maximum daily dose: 1,500 mg/day (HHS [pediatric] 2013) Adolescents: IV: 10 to 15 mg/kg/day every 24 hours as part of a multiple drug regimen (HHS [adult] 2015; HHS [pediatric] 2013) Peritonitis (CAPD): Infants, Children, and Adolescents: Intraperitoneal: Continuous: Loading dose: 25 mg per liter of dialysate; maintenance dose: 12 mg per liter (Warady 2012) Tuberculosis, drug-resistant (off-label use): Infants, Children, and Adolescents ≤14 ye

Refer to adult dosing.

Some patients may require larger or more frequent doses if serum levels document the need (ie, cystic fibrosis or febrile granulocytopenic patients). Adults: The following adjustments have been recommended: Note: Renally adjusted dose recommendations are based on a dose of 7.5 mg/kg every 12 hours (Aronoff 2007). GFR >50 mL/minute: No dosage adjustment necessary. GFR 10 to 50 mL/minute: Administer every 24 to 72 hours based on serum concentrations GFR Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Dialyzable (20%; variable; dependent on filter, duration, and type of HD): 5 to 7.5 mg/kg every 48 to 72 hours. Follow levels. Redose when pre-HD concentration Note: Dosing dependent on the assumption of 3 times/week, complete IHD sessions. Peritoneal dialysis (PD) (Li 2010): Intermittent dosing: 2 mg/kg per exchange once daily; allow to dwell ≥6 hours Continuous dosing (all exchanges): Loading dose: 25 mg/L; maintenance dose: 12 mg/L Continuous renal replacement therapy (CRRT) (Heintz 2009; Trotman 2005): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment: CVVH/CVVHD/CVVHDF: Loading dose of 10 mg/kg followed by maintenance dose of 7.5 mg/kg every 24 to 48 hours Note: For severe gram-negative rod infections, target peak concentration of 15 to 30 mg/L; redose when concentration Infants, Children, and Adolescents: There are no dosage adjustments provided in the manufacturer’s labeling; however, the following adjustments have been recommended (Aronoff 2007): Renally adjusted dose recommendations are based on doses of 5 to 7.5 mg/kg/dose every 8 hours. GFR >50 mL/minute/1.73 m2: No dosage adjustment necessary GFR 30 to 50 mL/minute/1.73 m2: Administer every 12 to 18 hours GFR 10 to 29 mL/minute/1.73 m2: Administer every 18 to 24 hours GFR 2: Administer every 48 to 72 hours Intermittent hemodialysis: 5 mg/kg/dose; redose as indicated by serum concentrations Peritoneal dialysis (PD): 5 mg/kg/dose; redose as indicated by serum concentrations Continuous renal replacement therapy (CRRT): 7.5 mg/kg/dose every 12 hours, monitor serum concentrations

There are no dosage adjustments provided in the manufacturer’s labeling.