In people with a CNS infection such as meningitis, amikacin can be given intrathecally (by direct injection into the spine) or intraventricularly (by injection into the ventricles of brain).An liposome inhalation suspension is also available and approved to treat Mycobacterium avium complex (MAC) in the United States. The application for Arikayce was withdrawn in the European Union because the Committee for Medicinal Products for Human Use (CHMP) was of the opinion that the benefits of Arikayce did not outweigh its risks. Special populations
Amikacin should be used in smaller doses in the elderly, who often have age-related decreases in kidney function, and children, whose kidneys are not fully developed yet. It is considered pregnancy category D in both the United States and Australia, meaning they have a probability of harming the fetus. Around 16% of amikacin crosses the placenta; while the half-life of amikacin in the mother is 2 hours, it is 3.7 hours in the fetus. A pregnant woman taking amikacin with another aminoglycoside has a possibility of causing congenital deafness in her child. While it is known to cross the placenta, amikacin is only partially secreted in breast milk.In general, amikacin should be avoided in infants.
It is rarely used alone.It is often used in the following situations:
Bronchiectasis
Bone and joint infections
Granulocytopenia, when combined with ticarcillin, in people with cancer
Intra-abdominal infections (such as peritonitis) as an adjunct to other medicines, like clindamycin, metronidazole, piperacillin/tazobactam, or ampicillin/sulbactam
Meningitis:
for meningitis by E. coli, as an adjunct to imipenem
for meningitis caused by Pseudomonas, as an adjunct to meropenem
for meningitis caused by Acetobacter, as an adjunct to imipenem or colistin
for neonatal meningitis caused by Streptococcus agalactiae or Listeria monocytogenes, as an adjunct to ampicillin
for neonatal meningitis caused by Gram negative bacteria such as E. coli, as adjunct to a 3rd-generation cephalosporin
Mycobacterial infections, including as a second-line agent for active tuberculosis. It is also used for infections by Mycobacterium avium, M. abcessus, M. chelonae, and M. fortuitum. Rhodococcus equi, which causes an infection resembling tuberculosis
Respiratory tract infections, including as an adjunct to beta-lactams or carbapenem for hospital-acquired pneumonia
Sepsis, including that in neonates, as an adjunct to beta-lactams or carbapenem
Skin and suture-site infections
Urinary tract infections that are caused by bacteria resistant to less toxic drugs (often by Enterobacteriaceae or P. aeruginosa)Amikacin may be combined with a beta-lactam antibiotic for empiric therapy for people with neutropenia and fever. Available forms
Amikacin may be administered once or twice a day and is usually given by the intravenous or intramuscular route, though it can be given via nebulization. There is no oral form available, as amikacin is not absorbed orally. In people with kidney failure, dosage must be adjusted according to the creatinine clearance, usually by reducing the dosing frequency.