Amikacin

Hypersensitivity to amikacin and other aminoglycoside antibiotics. Myasthenia gravis. Concomitant or sequential administration of oral or topical drugs that are neurotoxic, ototoxic or nephrotoxic; concomitant use with potent diuretics.

Patient with pre-existing vertigo, tinnitus, hearing loss, vestibular damage; family history of aminoglycoside-induced deafness; neuromuscular disorders (e.g. Parkinson's disease), hypocalcaemia. Dehydrated patients. Used as a 2nd-line treatment for staphylococcus infections. Patients with certain MT-RNR1 gene variants (e.g. m.1555A>G). Renal impairment. Neonates, children, and elderly. Pregnancy and lactation. Monitoring Parameters Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor renal function, urine (e.g. specific gravity, excretion of proteins, presence of cells or casts), BUN, creatinine, appropriately timed peak and trough concentrations, eighth cranial nerve function (especially in patients with known or suspected renal impairment). Perform hearing tests (audiograms) at baseline and periodically. Assess for signs and symptoms of ototoxicity, neurotoxicity and nephrotoxicity; vital signs, temperature, weight, input and output.

Significant: Hypersensitivity, neurotoxicity, ototoxicity, nephrotoxicity, neuromuscular blockade, respiratory paralysis, fungal or bacterial superinfection, Clostridium difficile-associated diarrhoea (CDAD), pseudomembranous colitis (prolonged use). Inhalation: Bronchospasm, haemoptysis, hypersensitivity pneumonitis and alveolitis; COPD, infective exacerbation of COPD or bronchiectasis. Blood and lymphatic system disorders: Anaemia, eosinophilia. Ear and labyrinth disorders: Tinnitus, hypoacusis, vertigo. Gastrointestinal disorders: Nausea, vomiting; diarrhoea, dry mouth, laryngitis, oral candidiasis, dysgeusia (inhalation). General disorders and administration site conditions: Pyrexia, injection site pain (IM); fatigue (inhalation). Investigations: Decreased weight (inhalation). Metabolism and nutrition disorders: Hypomagnesaemia. Musculoskeletal and connective tissue disorders: Arthralgia, muscle twitching; musculoskeletal pain (inhalation). Nervous system disorders: Balance disorder, headache, paraesthesia, tremor. Renal and urinary disorders: Oliguria, albuminuria, azotaemia, RBC urine, WBC urine. Respiratory, thoracic and mediastinal disorders: Cough, dyspnoea, dysphonia, wheezing, increased sputum, vocal cord inflammation, throat irritation, oropharyngeal pain (inhalation). Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria. Vascular disorders: Hypotension.

Additive neurotoxic, ototoxic or nephrotoxic effects with amphotericin B, bacitracin, cisplatin, ciclosporin, cefaloridine, paromomycin, polymyxin B, colistin, tacrolimus, vancomycin, viomycin, IV mannitol, or other aminoglycosides. Increased risk of ototoxicity with potent diuretics (e.g. etacrynic acid or furosemide); may increase risk of toxicity with IV diuretics. May increase risk of respiratory paralysis with anaesthetics or neuromuscular blocking agents (e.g. tubocurarine, succinylcholine, decamethonium, atracurium, rocuronium, vecuronium, opioid analgesic, massive transfusions with citrated anticoagulated blood). Increased risk of nephrotoxicity and may increase serum creatinine levels with cephalosporins. May reduce antibacterial activity with penicillins. Increased risk of hypocalcaemia with bisphosphonates. Increased risk of nephrotoxicity and ototoxicity with platinum drugs. May increase serum concentration with indometacin in neonates.

Aminoglycosides

S01AA21 - amikacin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
J01GB06 - amikacin ; Belongs to the class of other aminoglycosides. Used in the systemic treatment of infections.
D06AX12 - amikacin ; Belongs to the class of other topical antibiotics used in the treatment of dermatological diseases.