Amikacin Use in ESRD Patients

Pharmacokinetic Considerations

Amikacin clearance is almost exclusively renal, requiring significant dosage adjustments in ESRD patients, according to the Centers for Disease Control and Prevention 1, 2

For ESRD patients, the dosing frequency should be reduced to two or three times per week, but the dose should be maintained at 12-15 mg/kg to ensure concentration-dependent bactericidal effect, as recommended by the Centers for Disease Control and Prevention 3, 4
Administration should occur after dialysis to facilitate directly observed therapy and prevent premature removal of the drug, as suggested by the Centers for Disease Control and Prevention 3

Baseline and regular monitoring should include audiogram and vestibular testing, and monitoring for auditory or vestibular symptoms, as recommended by the Centers for Disease Control and Prevention 5, 6, 7

Nephrotoxicity: Amikacin may cause renal impairment in 8.7% of patients, with higher frequency in those with initially increased creatinine levels, according to the Centers for Disease Control and Prevention 5, 7
Ototoxicity: High-frequency hearing loss occurs in up to 24% of patients receiving amikacin, with higher rates in those receiving higher doses, as reported by the Centers for Disease Control and Prevention 7
Risk of toxicity increases with concurrent use of diuretics, larger total cumulative doses, and use of other nephrotoxic agents, as noted by the Centers for Disease Control and Prevention 3, 5, 6, 7

Administering amikacin before dialysis will result in premature removal of the drug and potential treatment failure, as warned by the Centers for Disease Control and Prevention 3