Single-Dose Amikacin for UTIs in ESRD Patients

Introduction to Aminoglycosides in UTIs

• Aminoglycosides, including amikacin, are ideal agents for single-dose treatment of uncomplicated lower UTIs in patients with normal renal function due to their concentration-dependent bactericidal effect and prolonged urinary concentrations 3, 4
• A meta-analysis of 13 studies with 13,804 patients found single-dose aminoglycoside treatment effective for lower UTIs with microbiologic cure rates of 87-100% in patients with normal renal function 3

Guidelines for UTI Treatment

• Current guidelines provide specific recommendations for UTIs caused by resistant organisms: for simple cystitis due to carbapenem-resistant Enterobacterales (CRE), single-dose aminoglycoside is recommended with a weak recommendation and very low quality of evidence 1, 5
• For complicated UTIs (cUTI), single-dose aminoglycoside is only recommended as an alternative regimen with weak recommendation and very low quality of evidence 6

Risks and Monitoring

• Amikacin use in ESRD carries significant risks of ototoxicity (hearing loss) and nephrotoxicity (further kidney damage) 2, 7
• Monitoring requirements in ESRD patients include baseline audiogram and vestibular testing, monthly assessment of renal function, and assessment for auditory or vestibular symptoms 2, 7

Alternative Treatment Options

• For complicated UTIs in patients with resistant organisms, guidelines recommend Ceftazidime-avibactam 2.5 g IV q8h (with dose adjustment for renal function) 1, 8
• Meropenem-vaborbactam or imipenem-cilastatin-relebactam (with dose adjustment) are also recommended 1, 5
• Plazomicin 15 mg/kg IV q12h (with dose adjustment) is another alternative 1, 5