Amikacin sulfate is a semi-synthetic, broad-spectrum aminoglycoside antibiotic derived from kanamycin A. It is a bactericidal agent primarily used for the treatment of serious Gram-negative bacterial infections, including those caused by multidrug-resistant (MDR) organisms like Pseudomonas aeruginosa and Acinetobacter species. It is a critical reserve antibiotic in the Indian context due to rising antimicrobial resistance.
Adult: 15 mg/kg/day administered as a single daily dose (preferred) OR divided into 2-3 equal doses. Typical dose: 500mg IV/IM every 8-12 hours or 15 mg/kg once daily. Maximum daily dose should not exceed 1.5 grams.
Note: For IV use: Dilute 500mg in 100-200 mL of compatible IV fluid (NS, D5W). Infuse over 30-60 minutes. For IM use: Administer by deep intramuscular injection into a large muscle mass. NEVER administer IV push/bolus. Monitor vital signs during infusion.
Amikacin binds irreversibly to the bacterial 30S ribosomal subunit, specifically at the A-site. This binding interferes with the initiation complex, misreads the genetic code on mRNA, and causes premature termination of protein synthesis. The result is the production of non-functional or truncated proteins, leading to bacterial cell death.
Pregnancy: Category D (US FDA). Aminoglycosides cross the placenta. There is a risk of fetal ototoxicity (8th cranial nerve damage). Use only if the potential benefit justifies the potential risk to the fetus, typically for life-threatening infections where safer alternatives are contraindicated.
Driving: Patients experiencing vestibular toxicity (vertigo, dizziness, loss of balance) should be advised not to drive or operate heavy machinery.
| Furosemide/Ethacrynic acid | Potentiates ototoxicity (additive damage to cochlea) | Major |
| Vancomycin, Amphotericin B, Cisplatin | Potentiates nephrotoxicity (additive renal tubular damage) | Major |
| Neuromuscular blocking agents (e.g., Succinylcholine, Vecuronium) | Potentiates neuromuscular blockade, may cause prolonged respiratory depression/apnea | Major |
| Penicillins (e.g., Carbenicillin, Ticarcillin) - high dose | In vitro inactivation of amikacin if mixed in same IV line/syringe; can lead to sub-therapeutic levels in vivo in patients with renal failure | Moderate |
| Indomethacin in neonates | May increase amikacin levels, increasing toxicity risk | Moderate |
Same composition (Amikacin (500mg)), different brands: