Amikacin (Antimicrobial)

A once daily regimen is preferred as this is safer for patients and more efficient without being any less effective than a multiple daily dose regimen.

Usual dose is 15mg/kg (maximum 1·5g) once a day with a maximum of 15g per course. There is a higher risk of ototoxicity with higher cumulative doses and longer treatment courses. The dose should be adjusted according to weight and degree of renal impairment.

Dose adjustment in obesity

If the patient is obese (greater than 120% of their IBW), use adjusted body weight, calculated as follows:

Ideal body weight (IBW) (kg):

Male IBW = 50 + (2.3 x (height in inches – 60))

Female IBW = 45 + (2.3 x (height in inches – 60))

Adjusted Bodyweight (AdjBW) (kg):  AdjBW = IBW +0.4 (actual body weight (kg) – IBW)

Target Concentrations

Prior to the second dose, take a trough level (immediately prior to dose) then a peak level (1 hour post dose) and then repeat these levels every 2 to 3 days thereafter.
Doses should continue to be administered whilst awaiting level as long as renal function is stable.
Samples are sent to via Raigmore Hospital Microbiology Laboratory to Bristol for analysis and are only processed Monday to Friday. Results should be available the following day but if sent on a Friday they would be back Monday at the earliest and later if a bank holiday.
Careful consideration therefore needs to be made if starting therapy on a Thursday or Friday as levels will not be available at the correct time to inform dosing. Microbiology should be involved and discussions had about the safety of treatment and whether or not an alternative therapy could be used in these situations.

• NHS Greater Glasgow and Clyde Adult Therapeutics Handbook Amikacin Dosing Guidance. Updated December 2018. Accessed 9/4/19 via http://handbook.ggcmedicines.org.uk/guidelines/infections/amikacin-dosing-guidelines-age-16-and-over