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Amikacin is an antimicrobial with activity against more resistant gram-negative bacilli such as Acinetobacter baumanii and Pseudomonas aeruginosa. It also has excellent activity against most aerobic gram-negative bacilli from the Enterobacteriaceae family, including Nocardia sp. and some Mycobacterium spp. (M. avium-intracellulare, M. chelonae, and M. fortuitum). Unlike gentamicin, amikacin does not provide synergistic activity against Enterococcus faecium when combined with beta-lactam antibiotics. This activity covers amikacin, its mechanism, activity spectrum, and its place in an infectious disease regimen. Members of the interprofessional team need to review its indications, coverage, contraindications, and adverse event profile to optimally manage patients with infectious disease. Objectives: Summarize the mechanism of action of amikacin. Identify the bacterial coverage and indications for amikacin. Review the adverse events of amikacin, including proper monitoring procedures. Explain amikacin's place in infectious disease management as it pertains to improving care coordination amongst the interprofessional team and in the context of antimicrobial stewardship. Access free multiple choice questions on this topic.

No antidote for toxicity is available, only 20% dialyzable; however, this is variable based on hemodialysis filter. Avoid potentially toxic prolonged peak concentrations above 35 mcg/mL. Drug Interactions Clindamycin, chloramphenicol, and tetracycline can inactivate amikacin and other aminoglycosides. High-ceiling diuretics like furosemide increase ototoxicity and have the potential to increase the concentration of amikacin, thereby worsening the ototoxicity. Other medications that can increase amikacin concentrations in the blood include NSAIDs (especially indomethacin) and quinidine.

Amikacin is a beneficial drug to treat aerobic gram-negative infections. Healthcare workers, including the clinicians who prescribe it, should always check renal function regularly as the drug is nephrotoxic. In many inpatient facilities, the clinician or infectious disease specialist will initiate amikacin as part of the antimicrobial regimen and then allow the clinical pharmacist to handle dosing and subsequent dose adjustment. Nursing will perform drug administration and should have open access to both the clinicians and the pharmacists. If problems arise, the nurse or pharmacist must reach out to the clinician to adjust therapy. The interprofessional team, including all clinicians, specialists, nurses, and pharmacists, should all be responsible for assessing treatment effectiveness and monitoring for side effects. [Level 5]