Amikacin

Contents

Amikacin

Amikacin is a broad spectrum semisynthetic aminoglycoside antibiotic that kills bacteria. Amikacin is used to treat severe or serious gram negative infections including those resistant to gentamicin or tobramycin. Amikacin injection is used to treat certain serious infections that are caused by bacteria such as meningitis (infection of the membranes that surround the brain and spinal cord) and infections of the blood, abdomen (stomach area), lungs, skin, bones, joints, and urinary tract. Amikacin is also sometimes used with other medications to treat tuberculosis (TB; a serious infection that affects the lungs and sometimes other parts of the body). Amikacin injection is for short-term use only (7 to 10 days). Talk to your doctor about the risks of using amikacin for your condition.

Like other aminoglycosides, amikacin is thought to act by binding to bacterial ribosomes and inhibiting protein synthesis. Nevertheless, amikacin is considered bacteriocidal as well as bacteriostatic. Amikacin and other aminoglycosides are typically used in combination with a penicillin or cephalosporin for treatment of severe infections with Pseudomonas aeruginosa, Enterobacter, Klebsiella, Serratia and other gram-negative bacteria resistant to less toxic antibiotics. Amikacin is most commonly used for septicemia, bacterial endocarditis, peritonitis, meningitis, pelvic inflammatory disease and pneumonia. Amikacin is also used in therapy of tuberculosis in combination with other antitubercular drugs.

Amikacin was approved for use in the United States in 1981 and is available in several generic parenteral formulations. The typical adult dose is 15 mg/kg per day im or iv, usually in two or three divided doses over 5 to 10 days. The dose of amikacin must be modified based upon renal function and monitoring of drug levels is advisable. Amikacin common side effects include dizziness, headache, confusion, nausea and skin rash. Importantly, dose related adverse effects of amikacin include oto- and nephrotoxicity, which are shared by all aminoglycosides.

Antibiotics such as amikacin injection will not work for colds, flu or other viral infections. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Amikacin injection comes as a liquid to be injected intravenously (into a vein) or intramuscularly (into a muscle) every 8 or 12 hours (two or three times a day). When amikacin is injected intravenously, it is usually infused (injected slowly) over a period of 30 to 60 minutes. The length of your treatment depends on the type of infection you have.

You may receive amikacin injection in a hospital or you may administer the medication at home. If you will be receiving amikacin injection at home, your healthcare provider will show you how to use the medication. Be sure that you understand these directions, and ask your healthcare provider if you have any questions.

You should begin to feel better during the first few days of treatment with amikacin injection. If your symptoms do not improve or get worse, call your doctor.

Use amikacin injection until you finish the prescription, even if you feel better. If you stop using amikacin injection too soon or skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.

IMPORTANT WARNING

Amikacin may cause serious kidney problems. Kidney problems may occur more often in older people or in people that are dehydrated. Tell your doctor if you have or have ever had kidney disease. If you experience any of the following symptoms, call your doctor immediately: decreased urination; swelling of the face, arms, hands, feet, ankles, or lower legs; or unusual tiredness or weakness.

Amikacin may cause serious hearing problems. Hearing problems may occur more often in older people or in people that are dehydrated. Hearing loss may be permanent in some cases. Tell your doctor if you have or have ever had dizziness, vertigo, hearing loss, or ringing in the ears. If you experience any of the following symptoms, call your doctor immediately: hearing loss, roaring or ringing in the ears, or dizziness.

Amikacin may cause nerve problems. Tell your doctor if you have or have ever had burning, tingling, or numbness in the hands, arms, feet, or legs; muscle twitching or weakness; or seizures.

The risk that you will develop serious kidney, hearing, or other problems is greater if you are taking certain medications. Tell your doctor and pharmacist if you are taking acyclovir (Zovirax, Sitavig); amphotericin (Abelcet, Ambisome, Amphotec); bacitracin; capreomycin (Capastat); certain cephalosporin antibiotics such as cefazolin (Ancef, Kefzol), cefixime (Suprax), or cephalexin (Keflex); cisplatin; colistin (Coly-Mycin S); cyclosporine (Gengraf, Neoral, Restasis, Sandimmune); diuretics (‘water pills’) such as bumetanide, ethacrynic acid (Edecrin), furosemide (Lasix), or torsemide (Demadex); other aminoglycoside antibiotics such as gentamicin, kanamycin, neomycin (Neo-Fradin), paromomycin, streptomycin or tobramycin; polymyxin B; or vancomycin (Vanocin). Your doctor may not want you to receive amikacin injection.

If you are having surgery, including dental surgery, tell the doctor or dentist that you are using amikacin injection.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests, including hearing tests, before and during treatment to check your body’s response to amikacin.

Amikacin mechanism of action

Amikacin binds irreversibly to the 30S bacterial ribosome subunit, resulting in interference with a reading of the genetic code and inhibition of protein synthesis. Amikacin, as well as the rest of the aminoglycosides, are generally bacteriocidal and probably have an additional mechanism of action which is yet to be determined.

Amikacin indications

Amikacin is rarely used alone and often combined with other antibiotics.

Amikacin indications include

  • Hospital-Acquired/Ventilator-Associated/Healthcare-Associated Pneumonia
  • Endophthalmitis, bacterial (intravitreal injection, OFF LABEL)
  • Meningitis (IV) or (Intrathecal/Intraventricular, OFF LABEL)
  • Wound infections caused by susceptible organisms
  • Urinary tract infections (Generally only if caused by resistant organisms, OFF LABEL)
  • Gram-negative Bacteremia/Sepsis (OFF LABEL)

Amikacin injection

Amikacin and other aminoglycosides are typically used in combination with a penicillin or cephalosporin for treatment of severe infections with Pseudomonas aeruginosa, Enterobacter, Klebsiella, Serratia and other gram-negative bacteria resistant to less toxic antibiotics. Amikacin is most commonly used for septicemia, bacterial endocarditis, peritonitis, meningitis, pelvic inflammatory disease and pneumonia. Amikacin is also used in therapy of tuberculosis in combination with other antitubercular drugs.

Amikacin injection is usually used for serious bacterial infections for which other medicines may not work. However, it may also cause some serious side effects, including damage to your hearing, sense of balance, and kidneys. These side effects may be more likely to occur in elderly patients and newborn infants. You and your doctor should talk about the benefits of this medicine as well as the risks.

Amikacin injection to be administered only by or under the immediate supervision of your doctor.

Amikacin inhalation

Amikacin inhalation (amikacin liposome) is used to treat adults with refractory (difficult to treat) Mycobacterium avium complex (MAC) lung disease as part of a combination antibacterial drug treatment plan (regimen). Amikacin inhalation (amikacin liposome) is available only with your doctor’s prescription.

Amikacin special precautions

Before receiving amikacin injection:

  • tell your doctor and pharmacist if you are allergic to amikacin injection; other aminoglycoside antibiotics such as gentamicin, kanamycin, neomycin, streptomycin, or tobramycin; sulfites; any other medications; or any of the ingredients in amikacin injection. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements, you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: other antibiotics such as amoxicillin (Amoxil, Larotid, Moxatag, in Augmentin, in Prevpac), ampicillin, or penicillin; dimenhydrinate (Dramamine); meclizine (Bonine); or nonsteroidal anti-inflammatory drugs such as indomethacin (Indocin, Tivorbex). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with amikacin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
  • tell your doctor if you are or have or have ever had cystic fibrosis (an inherited condition that affects the lungs and digestive system), problems with your muscles such as myasthenia gravis or Parkinson’s disease.
  • Tell your doctor if you are pregnant or plan to become pregnant or breastfeed. If you become pregnant while using amikacin injection, call your doctor immediately. Amikacin may harm the fetus.

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of amikacin injection in children. However, this medicine should be used with caution in premature and newborn infants.

Geriatric

No information is available on the relationship of age to the effects of amikacin injection in geriatric patients. However, elderly patients are more likely to have kidney problems, which may require caution and an adjustment in the dose for patients receiving amikacin injection.

Pregnancy

Pregnancy Category D: Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Amikacin injection drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving amikacin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using amikacin with any of the following medicines is not recommended. Your doctor may decide not to treat you with amikacin or change some of the other medicines you take.

  • Ataluren

Using amikacin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alcuronium
  • Atracurium
  • Cholera Vaccine, Live
  • Cidofovir
  • Cisatracurium
  • Colistimethate Sodium
  • Decamethonium
  • Doxacurium
  • Ethacrynic Acid
  • Fazadinium
  • Foscarnet
  • Furosemide
  • Gallamine
  • Hexafluorenium
  • Lysine
  • Mannitol
  • Metocurine
  • Mivacurium
  • Pancuronium
  • Pipecuronium
  • Rapacuronium
  • Rocuronium
  • Succinylcholine
  • Tubocurarine
  • Urea
  • Vancomycin
  • Vecuronium

Using amikacin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Ibuprofen

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Asthma or
  • Sulfite allergy, history of—This medicine contains sodium metabisulfite which may cause an allergic reaction in patients with these conditions.
  • Kidney disease, severe or
  • Muscle problems or
  • Myasthenia gravis (severe muscle weakness) or
  • Nerve problems or
  • Parkinson’s disease—Use with caution. May make these condition worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of this medicine from the body.

Amikacin inhalation drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Ethacrynic Acid
  • Furosemide
  • Mannitol
  • Urea

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Asthma or
  • Bronchospasm or
  • Chronic obstructive pulmonary disease (COPD) or
  • Hyperreactive airway disease—Must be treated first before using this medicine.
  • Ear or hearing problems or
  • Lung or breathing problems or
  • Nerve or muscle problems (eg, myasthenia gravis)—Use with caution. May make these conditions worse.

Amikacin administration

Amikacin can be administered parenterally or via nebulization. There is no oral formula of the drug available because the drug is not absorbed from the gastrointestinal tract. A nurse or other trained health professional will give you amikacin injection. Amikacin can be administered as a shot into a muscle (intramuscularly or IM) when intravenous (IV) access is not available. In some patients with meningitis, amikacin can be administered intrathecally and reaches high levels in the cerebrospinal fluid immediately 1).

To help clear up your infection completely, keep using amikacin injection for the full time of treatment, even if you begin to feel better after a few days. Also, amikacin injection works best when there is a constant amount in the blood. To help keep the amount constant, you must receive amikacin injection on a regular schedule.

To keep your kidneys working well and help prevent kidney problems, drink extra fluids so you will pass more urine while you or your child are receiving amikacin injection.

Your doctor will check your progress closely while you or your child are receiving amikacin. This will allow your doctor to see if amikacin is working properly and to decide if you or your child should continue to receive it. Blood, urine, hearing, and nerve tests may be needed to check for unwanted effects.

If your or your child’s symptoms do not improve within a few days, or if they become worse, check with your doctor.

Using amikacin while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using amikacin, tell your doctor right away.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have itching; hives; hoarseness; shortness of breath; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth after you receive amikacin.

Stop using amikacin and check with your doctor right away if you or your child have sudden decrease in hearing or loss of hearing, which may be accompanied by dizziness and ringing in the ears. Tell your doctor if you or your child have dizziness or lightheadedness; feeling of constant movement of self or surroundings; or sensation of spinning. These may be symptoms of a damage to your hearing or sense of balance.

Tell your doctor right away if you have trouble using your muscles or trouble breathing while receiving amikacin.

Check with your doctor right away if you or your child have blood in the urine, change in frequency of urination or amount of urine, difficulty with breathing, drowsiness, increased thirst, loss of appetite, nausea or vomiting, swelling of feet or lower legs, or weakness. These may be symptoms of a serious kidney problem.

This medicine may cause nerve problems. Check with your doctor right away if you or your child have numbness, skin tingling, muscle twitching, or seizures.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Amikacin dose adjustments

Therapeutic drug monitoring/range:

  • Peak: Less than 35 mcg/mL
  • Trough: Less than 10 mcg/mL
  • Peak and trough levels should be measured intermittently throughout treatment.

Lack of clinical response within 3 to 5 days:

  • Stop treatment and recheck antibiotic susceptibility of the organism.

Signs/symptoms of ototoxicity (e.g., dizziness, hearing loss, raring in the ears, tinnitus, vertigo): Discontinue the drug OR adjust the dose.

Amikacin inhalation

Amikacin inhalation is given through the Lamira™ Nebulizer System. Follow the instructions carefully on how to use it. Do not use the nebulizer system with any other medicine.

If you are using a bronchodilator (reliever) medicine for your lung or breathing problem, you should take it first before using amikacin inhalation.

Keep using amikacin inhalation for the full treatment time even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Amikacin dose

Amikacin dosing is based on your body weight (Kg) 2):

  • Underweight or Nonobese: dose on ACTUAL body weight
  • Obese (ACTUAL body weight/Ideal Body Weight > or = to 1.25): dose on DOSING body weight (DOSING body weight = Ideal Body Weight + 0.4(Actual body weight – Ideal Body Weight)

Adult Dosing:

  • Conventional Dosing: 5mg/kg IV every 8 hours, Elderly often require only each 12 hr interval
  • Adjustment for renal impairment (assuming every 8-hr dosing)
    • > 50 mL/min
    • (creatinine clearance [not GFR])
    • : no adjustment
    • 30-50 mL/min: every 12 to 18 hrs
    • 10-29 mL/min: every 18 to 24 hr
    • < 10 mL/min: dose based on levels or consult a pharmacist.

Once Daily Dosing:

  • Not to be used in patients with ascites, > 20% Body Surface Area (BSA) burns, pregnant patients, or patients on dialysis. (Use conventional dosing or consult pharmacist.)
  • 15 mg/kg per dose once daily

Adjustment for renal impairment:

  • 60 mL/min (creatinine clearance [not GFR]) and above: every 24 hours
  • 40-59 mL/min: every 36 hours
  • 30-39 mL/min: every 48 hours
  • < 30mL/min: Use conventional dosing method

Intravitreal:

  • 0.4 mg/0.1 mL of Normal Saline (preservative free formulation, OFF LABEL)

Intrathecal/intraventricular:

  • 5 to 50mg/day, usual dose is 30mg (preservative free formulation, OFF LABEL)

Amikacin inhalation

There is also liposomal amikacin undergoing clinical trials for the treatment of respiratory infections in patients with cystic fibrosis and bronchiectasis. In the trials, the liposomal formula is being used to treat nontuberculous bacteria and pseudomonas aeruginosa.

Adult Dose for Bacteremia

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:

  • 15 to 20 mg/kg IV every 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Empirical treatment of patients with healthcare-associated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Adult Dose for Intraabdominal Infection

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:

  • 15 to 20 mg/kg IV every 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Empirical treatment of patients with healthcare-associated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Adult Dose for Joint Infection

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:

  • 15 to 20 mg/kg IV every 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Empirical treatment of patients with healthcare-associated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Adult Dose for Osteomyelitis

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:

  • 15 to 20 mg/kg IV every 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Empirical treatment of patients with healthcare-associated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Adult Dose for Pneumonia

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:

  • 15 to 20 mg/kg IV every 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Empirical treatment of patients with healthcare-associated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Adult Dose for Skin or Soft Tissue Infection

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:

  • 15 to 20 mg/kg IV every 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Empirical treatment of patients with healthcare-associated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Adult Dose for Urinary Tract Infection

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV (over 30 to 60 minutes) 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • This drug should not be used to treat initial uncomplicated urinary tract infections unless the causative organisms are not susceptible to less potent antibiotics.

Uses:

  • Short-term treatment of serious complicated and recurrent urinary tract infections caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species
  • Uncomplicated initial episodes of urinary tract infections caused by organisms not susceptible to antibiotics having less potential toxicity

Adult Dose for Meningitis

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use: Treatment of meningitis and serious infections of the central nervous system caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:

  • Healthcare-Associated Ventriculitis and Meningitis:
    • IV: 15 mg/kg IV per day, given in divided doses every 8 hours
    • Intraventricular: 5 to 50 mg via intraventricular route once a day

Duration of therapy:

  • Neisseria meningitis or Haemophilus influenzae: 7 days
  • Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
  • Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, Staphylococcus aureus or gram-negative bacilli with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
  • Streptococcus pneumoniae: 10 to 14 days
  • Streptococcus agalactiae: 14 to 21 days
  • Aerobic gram-negative bacilli: 21 days
  • Listeria monocytogenes: At least 21 days
  • Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture

Comments:

  • The usual intraventricular dose was 30 mg/day.
  • The intraventricular drain should be clamped for approximately 15 to 60 minutes to allow the drug to equilibrate.

Use: Treatment of healthcare-associated ventriculitis and meningitis

Adult Dose for Peritonitis

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use: Treatment of peritonitis caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

International Society for Peritoneal Dialysis (ISPD) Recommendations:

  • Intermittent (1 exchange daily): 2 mg/kg intraperitoneally once a day
  • Continuous (all exchanges):
    • Loading dose: 25 mg/L
    • Maintenance dose: 4 mg/L

Comments:

  • Intermittent dosing is recommended, and should be allowed to dwell for at least 6 hours.
  • Prolonged courses of treatment should be avoided.

Use: Treatment of peritonitis

Adult Dose for Bacterial Infection

US Department of Health and Human Services (US HHS), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and US Centers for Disease Control and Prevention (US CDC) Recommendations:

  • 10 to 15 mg/kg IV once OR 25 mg/kg IV 3 times a week

Use: Treatment of mycobacterial infections

Adult Dose for Tuberculosis – Active

ATS, US CDC, IDSA Recommendations:

  • 15 mg/kg IM or IV once a day OR 25 mg IM or IV 3 times a week

Comment: Patients with renal dysfunction and/or those who are older may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Adult Dose for Mycobacterium avium-intracellulare

ATS and IDSA Recommendations:

  • Severe, extensive (multilobar) fibro cavitary disease OR previously treated disease: 25 mg/kg IV 3 times a week
    • Duration of therapy: 2 to 3 months
  • Nodular/bronchiectatic disease: 8 to 10 mg/kg IM or IV 2 to 3 times a week
    • Maximum dose: 500 mg/dose (patients older than 50 years)
    • Duration of therapy: At least 2 months (extensive disease)

Comment: A longer duration of therapy may be used in patients with very extensive disease and/or in those who cannot tolerate other agents.

US HHS, NIH, HRSA, and US CDC Recommendations:

  • 10 to 15 mg/kg IV once a day

Comment: This drug may be considered as a third or fourth drug in patients with advanced immunosuppression (e.g., CD4 counts less than 50 cells/mcL), high mycobacterial loads (greater than 2 log CFU/mL), or in the absence of effective antiretroviral therapy.

Use: Third or fourth drug option as an alternative treatment in patients with disseminated Mycobacterium avium complex (MAC) disease

Geriatric Dose for Bacteremia

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:

  • Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:
  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Geriatric Dose for Intraabdominal Infection

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Geriatric Dose for Joint Infection

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Geriatric Dose for Osteomyelitis

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Geriatric Dose for Pneumonia

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Geriatric Dose for Skin or Soft Tissue Infection

  • 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:

  • 10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week

Duration of therapy:

  • Initial therapy: At least 2 weeks
  • Serious skin and soft tissue infections: At least 4 months
  • Bone infections: At least 6 months

Comments:

  • Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
  • This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Geriatric Dose for Tuberculosis – Active

ATS, US CDC, and IDSA Recommendations:

  • 15 mg/kg IM or IV once a day OR 15 to 25 mg IM or IV 3 times a week

Comment: Patients with renal dysfunction and/or those who are older may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Pediatric Dose for Bacteremia

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Neonatal sepsis
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:

  • 15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Treatment of patients with complicated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections
    Pediatric Dose for Intraabdominal Infection

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Neonatal sepsis
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:

  • 15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Treatment of patients with complicated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Pediatric Dose for Joint Infection

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Neonatal sepsis
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:

  • 15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Treatment of patients with complicated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Pediatric Dose for Osteomyelitis

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Neonatal sepsis
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:

  • 15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Treatment of patients with complicated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Pediatric Dose for Pneumonia

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Neonatal sepsis
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:

  • 15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Treatment of patients with complicated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Pediatric Dose for Skin or Soft Tissue Infection

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:

Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

  • Bacterial septicemia
  • Neonatal sepsis
  • Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
  • Serious postoperative infections, including postvascular surgery
  • Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:

  • 15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

  • Initial doses should be based on body weight.
  • Maintenance doses should be determined by concentration monitoring.

Uses:

  • Treatment of patients with complicated intra-abdominal infections
  • Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Pediatric Dose for Meningitis

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Use: Treatment of meningitis and serious infections of the central nervous system caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

IDSA Recommendations:

Bacterial Meningitis:

  • 0 to 7 days: 15 to 20 mg/kg IV per day, given in divided doses every 12 hours
  • 8 to 28 days: 30 mg/kg IV per day, given in divided doses every 8 hours
  • Infants and children: 20 to 30 mg/kg IV per day, given in divided doses every 8 hours

Use: Adjunct empirical treatment of purulent meningitis caused by S agalactiae, E coli, L monocytogenes, Klebsiella species in patients younger than 1 month

IDSA, AAN, AANS, and NCS Recommendations:

Healthcare-associated Ventriculitis and Meningitis:

Infants and children:

  • IV: 22.5 mg/kg IV per day, given in divided doses every 8 hours
  • Intraventricular: 5 to 50 mg via intraventricular route once a day

Duration of therapy:

  • Neisseria meningitis or Haemophilus influenzae: 7 days
  • Coagulase-negative staphylococcus or P acnes with no/minimal cerebrospinal fluid pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
  • Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or gram-negative bacilli with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
  • S pneumoniae: 10 to 14 days
  • S agalactiae: 14 to 21 days
  • Aerobic gram-negative bacilli: 21 days
  • L monocytogenes: At least 21 days
  • Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture

Comments:

  • Neonate duration of therapy is 2 weeks beyond the first sterile CSF culture OR at least 3 weeks, whichever is longer.
  • The usual intraventricular dose was 30 mg/day.
  • The intraventricular drain should be clamped for approximately 15 to 60 minutes to allow the drug to equilibrate.

Use: Treatment of healthcare-associated ventriculitis and meningitis

Pediatric Dose for Peritonitis

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals

  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Use: Treatment of peritonitis caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

ISPD Recommendations:

Continuous peritoneal dialysis:

  • Loading dose: 25 mg/L
  • Maintenance dose: 12 mg/L

Intermittent peritoneal dialysis:

  • Anuric patients: 0.6 mg/kg intraperitoneally once a day
  • Non-anuric patients: 0.75 mg/kg intraperitoneally once a day

Comments:

  • Continuous: Loading doses should be allowed to dwell for at least 3 to 6 hours.
  • Intermittent: Doses should be administered via the long-dwell (unless otherwise specified) and be allowed to dwell for at least 6 hours.
  • Prolonged courses of treatment should be avoided.

Use: Treatment of peritonitis

Pediatric Dose for Urinary Tract Infection

Newborns:

  • Loading dose: 10 mg/kg IM once
  • Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Older infants and children:

  • Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
  • Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
  • Maximum dose: 15 mg/kg/day
  • Duration of therapy: 7 to 10 days

Comments:

  • Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
  • Heavier patients should not exceed 1.5 grams/day.
  • Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
  • Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
  • Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
  • This drug should not be used to treat initial uncomplicated urinary tract infections unless the causative organisms are not susceptible to less potent antibiotics.

Uses:

  • Short-term treatment of serious complicated and recurrent urinary tract infections caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species
  • Uncomplicated initial episodes of urinary tract infections caused by organisms not susceptible to antibiotics having less potential toxicity

Pediatric Dose for Bacterial Infection

American Academy of Pediatrics (AAP) Recommendations:

Severe Infections:

  • 7 days or younger and 2 kg or less: 15 mg IV or IM every 48 hours
  • 7 days or younger and greater than 2 kg: 15 mg IV or IM every 24 hours
  • 8 to 28 days and 2 kg or less: 15 mg IV or IM every 24 hours
  • 8 to 28 days and greater than 2 kg: 17.5 mg every 24 hours
  • Older than 28 days: 15 to 22.5 mg IV or IM in 2 to 3 doses OR 15 to 20 mg IV or IM once a day

Comments:

  • Serum concentrations should guide ongoing treatment.
  • Patients with cystic fibrosis should receive higher doses.

Pediatric Dose for Mycobacterium avium-intracellulare

US HHS, NIH, HRSA, and US CDC Recommendations:

  • 15 to 30 mg/kg IV in 1 to 2 divided doses per day
  • Maximum dose: 1.5 grams/day
  • Duration of therapy: At least 12 months

Comments:

  • If rifabutin cannot be administered AND a third agent must be added to a macrolide and ethambutol, this drug may be used.
  • This drug may be added in patients with more severe symptoms or disseminated disease requiring a fourth agent.

Use: Third or fourth drug option as an alternative treatment in patients with disseminated MAC disease

Pediatric Dose for Tuberculosis – Active

SIS and IDSA Recommendations:

  • Children: 15 to 20 mg/kg IM or IV once a day OR 25 to 30 mg/kg IM or IV 2 times a week

Comment: Patients with renal dysfunction may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

AAP, US HHS, NIH, HRSA, and US CDC Recommendations:

  • Infants, Children, and Adolescents: 15 to 30 mg/kg IM or IV once a day
    • Maximum dose: 1 gram
    • Duration of therapy: 2 months (with isoniazid, rifampin, and pyrazinamide)

Comment: Some experts state that this regimen may be used as an adjunctive treatment/second-line for drug-susceptible tuberculosis in HIV-infected patients undergoing DOT.

Uses:

  • Adjunctive treatment of drug-resistant tuberculosis
  • Adjunctive treatment of drug-susceptible meningitis caused by M bovis in geographic areas where resistance to streptomycin is common

Renal Dose Adjustments

Known/suspected renal dysfunction: Frequent monitoring recommended.

IM Administration:

  • Prolonged intervals (creatinine clearance unknown): Administer the recommended single dose (7.5 mg/kg IM) at the dosage interval determined by multiplying the serum creatinine by 9
  • Reduced dose (serum assay concentrations unknown):
    • Loading dose: 7.5 mg/kg IM once
    • Maintenance dose given IM every 12 hours: (observed creatinine clearance divided by normal creatinine clearance) multiplied by the loading dose OR recommended dose divided by the steady state creatinine clearance

Signs/symptoms of renal irritation occurring during treatment (e.g., casts, white/red cells, albumin): Increase hydration.

Evidence of renal dysfunction occurring during treatment (e.g., decreased creatinine clearance, decreased urine specific gravity, increased blood urea nitrogen/creatinine, oliguria): Dose reductions should be considered; closely monitor renal and eighth nerve function.

Increased azotemia OR a progressive decrease in urinary output occurring during treatment: Stop treatment.

Evidence of nephrotoxicity: Discontinue the drug OR adjust the dose.

SIS and IDSA Recommendations:

  • Renal dysfunction: Patients may require 15 mg/kg given 3 times a week

US HHS, NIH, HRSA, and US CDC Recommendations:

Renal dysfunction: Use with caution; dose adjustments should be determined by target peak and trough concentrations.

Liver Dose Adjustments

  • Data not available

Amikacin inhalation dose

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For inhalation dosage form (suspension):

  • For Mycobacterium avium complex lung disease:
    • Adults—One inhalation once a day using the Lamira™ Nebulizer System. Each dose contains 590 milligrams (mg) per 8.4 milliliters (mL) of amikacin.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of amikacin inhalation, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Amikacin side effects

Amikacin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • nausea
  • vomiting
  • diarrhea
  • headache
  • fever

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

  • rash
  • peeling or blistering of the skin
  • itching
  • hives
  • swelling of the eyes, face, throat, tongue, or lips
  • difficulty breathing or swallowing
  • hoarseness
  • severe diarrhea (watery or bloody stools) that may occur with or without fever and stomach cramps (may occur up to 2 months or more after your treatment)

Incidence not known:

  • agitation
  • black, tarry stools
  • bloody or cloudy urine
  • bluish lips or skin
  • blurred vision
  • burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
  • chest pain
  • chills
  • coma
  • confusion
  • cough
  • decrease in the amount of urine
  • decreased urine output
  • depression
  • difficulty with breathing
  • difficulty with moving
  • dizziness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • drowsiness
  • dry mouth
  • feeling of fullness in the ears
  • fever
  • headache
  • hearing loss
  • irritability
  • lethargy
  • loss of balance
  • loss or change in hearing
  • muscle pain or stiffness
  • muscle twitching
  • nausea
  • not breathing
  • pain in the joints
  • pain in the lower back or side
  • painful or difficult urination
  • pale skin
  • rapid weight gain
  • ringing or buzzing in the ears
  • seizures
  • shakiness in the legs, arms, hands, or feet
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • stupor
  • sweating
  • swelling of the face, ankles, or hands
  • swollen glands
  • thirst
  • trembling or shaking of the hands or feet
  • trouble with hearing
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Amikacin may cause other side effects. Call your doctor if you have any unusual problems while taking amikacin.

References   [ + ]

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