Amikacin: Brands, Price & Uses in Bangladesh

Amikacin is an aminoglycoside antibiotic used for the short-term treatment of serious bacterial infections caused by susceptible gram-negative organisms, and as part of combination therapy for certain other infections.

Established/FDA-approved uses

• Septicemia (including neonatal sepsis)
• Serious lower respiratory tract infections caused by susceptible gram-negative organisms (e.g. Pseudomonas aeruginosa, Klebsiella, Enterobacter, Serratia)
• Complicated and recurrent urinary tract infections
• Intra-abdominal infections, including peritonitis
• Skin, bone, and soft tissue infections, including those due to burns and post-operative infections
• Central nervous system infections (e.g. bacterial meningitis) caused by susceptible organisms, usually as adjunct therapy

Guideline-supported / combination uses

• Empiric therapy of suspected gram-negative sepsis, often combined with a beta-lactam antibiotic pending culture and susceptibility results
• As part of a multidrug regimen for multidrug-resistant tuberculosis (MDR-TB), used as a second-line injectable agent per WHO guidance when other options are unavailable or not tolerated
• Combined with a cell-wall-active agent (e.g. a penicillin) for synergy in selected serious infections such as enterococcal or streptococcal endocarditis

Amikacin is not the drug of choice for infections caused by organisms susceptible to antibiotics with a narrower toxicity profile, and therapy should be guided by culture and susceptibility testing whenever possible.

Amikacin is administered by intramuscular injection or intravenous infusion; dosing is individualized based on body weight, renal function, indication, and (where available) serum drug concentrations.

Adults and children with normal renal function

Neonates and infants

Dosing is weight- and age-based (e.g. loading dose followed by maintenance doses at extended intervals in neonates, per neonatal dosing references) and must be individualized by a physician; see Use in Special Populations.

Renal impairment

Dose and/or dosing interval must be reduced in patients with renal impairment, guided by creatinine clearance and, where possible, serum drug level monitoring, because Amikacin is eliminated renally and accumulates in reduced renal function.

Antibiotic stewardship: Take exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice, even if symptoms improve before the course is finished.

The most important adverse effects of Amikacin are nephrotoxicity and ototoxicity; other effects are generally less common.

• Nephrotoxicity: Amikacin can cause dose-related kidney damage, seen as rising blood urea nitrogen/creatinine, reduced urine output, or proteinuria; usually reversible on discontinuation but can be severe.
• Ototoxicity: both auditory (hearing loss, tinnitus) and vestibular (dizziness, vertigo, unsteadiness) toxicity can occur and may be irreversible; risk increases with higher doses, longer duration, pre-existing renal impairment, and concurrent ototoxic drugs.
• Neuromuscular blockade: rare but serious; can cause muscle weakness and respiratory paralysis, particularly with concurrent anesthetics/neuromuscular blockers or in myasthenia gravis.
• Other: injection site pain/irritation, rash, fever, headache, nausea, and, rarely, blood count changes or eosinophilia.