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Amikacin
See also Aminoglycoside antibiotics
General information
Amikacin is a semisynthetic derivative of kanamycin with similar pharmacokinetic properties and dosages. It is resistant to many of the bacterial R factor-mediated enzymes that inactivate kanamycin and gentamicin. Noteworthy is its effect against Pseudomonas aeruginosa and against most Gram-negative aerobes that are resistant to gentamicin and tobramycin. There are strains of Staphylococcus aureus that inactivate amikacin by phosphorylation and adenylation. Ticarcillin or azlocillin plus amikacin is considered one of the most efficacious empiric antibiotic combinations in febrile granulocytopenia in patients with cancer. On a weight basis amikacin is less active than gentamicin, and so the usual dose is 10–20 mg/kg/day. Whenever possible, peak concentrations of 40 μg/ml and trough concentrations of 10 μg/ml should not be exceeded during twice-daily dosing.
Organs and systems
Cardiovascular
Episodes of hypotension have been attributed to amikacin [ ].
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A 68-year-old woman on continuous ambulatory peritoneal dialysis was given amikacin (250 mg/day) and on the third day fainted and had a blood pressure of 90/60 mmHg. On the next 2 days, she had episodes of postural hypotension of between 90/60 and 80/50 mmHg two or three times a day. She was given antibiotics for the next 6 days and felt very bad the entire time, with a blood pressure of 80/50 mmHg. Her condition improved 2 days after withdrawal of amikacin and the episodes of hypotension did not recur.
Respiratory
Amikacin may have been the causative agent in an apneic episode in an infant on peritoneal dialysis [ ].
Sensory systems
Eyes
Preretinal hemorrhages [ ] and macular toxicity [ ] have been described after intravitreal injection of amikacin.
Hearing
Ototoxicity was observed in three of 195 patients who received amikacin (15 mg/kg/day) with either cefepime (2 g bd) or ceftazidime (2 g tds) [ ]. Two patients had severe loss of hearing, which persisted after drug withdrawal and resulted in permanent disability. The other had mild ototoxicity that required no action and resolved spontaneously.
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