Amikacin Dosing Guidelines for Tubercular Meningitis

Standard Dosing Regimen

The Centers for Disease Control and Prevention recommends amikacin at 15 mg/kg/day for adults with tuberculosis, typically administered as a single daily dose (5-7 days/week) initially 1
After the first 2-4 months or after culture conversion, the frequency can be reduced to two or three times a week, depending on the efficacy of other drugs in the regimen 1
The maximum daily dose should not exceed 1 gram 1

Baseline assessment should include audiogram, vestibular testing, Romberg testing, and serum creatinine measurement 1
Monthly assessments of renal function and questioning regarding auditory or vestibular symptoms should be performed 1
Audiogram and vestibular testing should be repeated if symptoms of eighth nerve toxicity develop 1

For patients over 59 years of age, the dose should be reduced to 10 mg/kg/day (500 mg for a 50kg patient) 1, 2
In patients with renal impairment, the dosing frequency should be reduced while maintaining the mg/kg dose at 12-15 mg/kg to ensure concentration-dependent bactericidal effect 1, 3
Amikacin has poor penetration into the cerebrospinal fluid, even in patients with meningitis, which may necessitate higher systemic doses to achieve therapeutic levels in the CNS 1

Ototoxicity (vestibular and hearing disturbances) is the most important adverse reaction 1
Risk of ototoxicity increases with age, concomitant use of loop-inhibiting diuretics, increasing single doses, and cumulative dose (especially above 100-120g) 1
Nephrotoxicity occurs less commonly with amikacin than with other aminoglycosides but should still be monitored 1
Circumoral paresthesias immediately after injection are relatively common 1