Amikacin tablets (Amikacin) is a popular semisynthetic antibiotic of the aminoglycoside group. Completely useless against anaerobes, but effective against pathogenic aerobes (gram-positive, gram-negative), blocks protein synthesis, disrupts the integrity of cytoplasmic membranes, has a bactericidal and bacteriostatic effect, maintaining a therapeutic effect for up to 12 hours.
Existing forms of release and composition
The drug is not available in tablets or capsules to suppress infection. Manufacturers offer only 2 forms of release:
- Colorless solution in ampoules (2.4 ml) for intramuscular, intravenous administration
- Hygroscopic white powder for preparing a solution.
Packaging: bottles (10 ml). Packaging - contour cell blisters containing instructions for use, 1.5, 10, 50 bottles. The pack is cardboard.
One ampoule contains one 1g (500mg) of the only active ingredient (sulfate Amikacin). In addition for diluting injections: sulfuric acid, sodium bisulfite, sodium citrate, distilled water.
"Amikacin". Recipe in Latin
When prescribing this drug, the doctor is obliged to write out a prescription on a strictly defined form, indicating all the necessary details. After which the document is given to the patient and he goes to the pharmacy to purchase the medicine.
A prescription for “Amikacin” is written in Latin. The form used is form No. 107-1/у.
You can see what the Amikacin recipe looks like in Latin in the photo below.
However, just having a prescription is not enough. It is necessary that the recipe for “Amikacin” in Latin be correctly formatted and have all the necessary details.
These include:
- stamp of a medical institution;
- prescription date;
- the patient’s full name, age category, number of years;
- the doctor's full name, signature and seal.
In the Rp column (short for Recipe - “prepare”), the doctor indicates the name of the drug, its concentration, volume and number of ampoules.
For example:
Rp: Solutionis Amikacini (Amikacin solution in Latin) 0.5 - 4 ml.
Dtd (Da tales doses - “give out such doses”) n 10 in ampullis.
This is what the recipe for Amikacin looks like in Latin. For children, the dosage may vary. In standard cases, it is 0.25 grams per day.
Column S (short for signa - “designate”) of the recipe for Amikacin ampoules in ampoules in Latin is filled out by the doctor. It must indicate in detail how the medicine is used, in what dosage and with what frequency it should be taken.
An example of a recipe signature for “Amikacin” in Latin:
S.: Inject into the gluteal muscle once a day for 10 days.
A prescription for amikacin sulfate in Latin should be provided to the pharmacy. There, the pharmacist or pharmacist will select the right medicine, make the appropriate notes on the dispensing and return the prescription form to your hands. The pharmacy does not keep the recipe for Amikacin in Latin for storage.
pharmachologic effect
A representative of aminoglycosides, a new generation antibiotic has proven highly effective against a number of gram-negative and gram-positive aerobes. Taking into account the administered dose, Amikacin has bacteriostatic and bactericidal properties to a certain extent:
- quickly penetrates histohematic barriers;
- absorbed into all extracellular fluids and tissues;
- evenly distributed;
- blocks protein synthesis, destroys the cytoplasmic membranes of bacteria;
- isolates the formation of RNA complexes;
- binds tightly to the 30S ribosomal subunit;
- provokes the death of parasitic cells.
The half-life through the kidneys is 11 hours.
The active substance is not subject to transformation. The connection with blood proteins does not exceed 10%.
Amikacin after intramuscular or intravenous administration has the highest antibacterial effect after 10-12 hours. A high concentration of the active substance is capable of penetrating almost all tissues and fluids of the body (liver, kidneys, lungs, myocardium, bronchial secretions, sputum, muscles, fat deposits, spinal secretions).
A representative of the aminoglycoside group easily penetrates the placenta and can appear in the amniotic fluid and blood of the unborn baby or breast milk. This means that it is completely contraindicated for women during pregnancy and lactation.
Pharmacological properties of the drug Amikacin
An aminoglycoside antibiotic with a broad spectrum of activity against gram-positive and gram-negative bacteria. Has a bactericidal effect. It is obtained semi-synthetically from kanamycin A. After intramuscular administration, it is quickly absorbed and distributed in the body. It is excreted unchanged in the urine mainly due to glomerular filtration. About 20% of the antibiotic binds to blood plasma proteins. A number of gram-negative microorganisms are sensitive to amikacin, including Pseudomonas spp., E. coli, Proteus spp . (indole-positive and indole-negative strains), Klebsiella spp., Enterobacter spp., Serratia spp., Salmonella spp., Shigella spp., Mima Herellea, Citrobacter freundii, Providencia spp., as well as gram-positive microorganisms ( Staphylococcus spp. and some strains of Streptococcus pneumoniae ). The antibiotic does not affect most anaerobes. Many strains of gram-negative microorganisms resistant to gentamicin may be sensitive to amikacin. Staphylococci resistant to penicillin, methicillin, and some cephalosporins are sensitive to amikacin.
Indications for use of Amikacin
The medicine is prescribed by doctors for diseases of varying severity with an infectious-inflammatory course:
- pneumonia;
- lung abscess;
- bronchitis;
- meningitis;
- septic endocarditis;
- lung abscess;
- pleural empyema;
- osteomyelitis;
- peritonitis
- cystitis;
- urethritis;
- pyelonephritis;
- bedsores of any origin;
- infected ulcers, wounds;
- postoperative, wound infections of the skin, soft tissues and hepato-biliary system.
The drug is most effective against gram-negative aerobes. Anaerobic pathogens are resistant and the drug is not used. Activity against streptococci is moderate. For fecal enterococci - enhanced bactericidal.
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How to take Amikacin?
The drug is injected into a vein, intramuscularly only in a stream or drip over 35 minutes, but only before testing the sample for sensitivity to the antibiotic.
The daily dose is selected taking into account the stage of the pathological process, age and individual characteristics of the patients. On average, for adults and children over 12 years of age it is 5-7.5 mg/1 kg of weight. So every 8-12 hours.
The highest dose is 15 mg/1 kg. For bacterial urinary tract infection - 250 mg, hemodialysis - 5 mg/kg, burns - 5-7.5 mg/kg every 4-6 hours.
Duration of therapy is up to 7 days when administered intravenously, up to 10 days when administered intramuscularly. Doses are reduced to 7.5 mg/kg and the intervals between doses are increased in case of kidney pathologies. The dosage regimen does not change.
If the level of creatinine clearance is not detected and the patient’s condition is stable, the hourly administration interval is 8-9 hours or every 18 hours if the serum creatinine concentration does not exceed 2 mg/100 ml.
For children
A completely non-toxic antibiotic is considered approved for children from birth for inhalation, drip placement if diseases of the ENT, urinary, and respiratory systems with an infectious-inflammatory course are diagnosed.
Doses according to instructions:
- newborns - 10 mg/kg with a gradual decrease and 7.5 mg/kg, administered every 12 hours up to 10 days;
- 1-6 years - 10 mg/kg for 3 days with a gradual transition to 7.5 mg/kg by injection every 22 hours;
- 6-12 years – up to 7.5 mg/kg after 8-12 hours;
- after 12 years - 5-15 mg/kg per day.
Important! Amikacin sulfate is an active aminoglycoside, therefore it is prescribed with caution to premature babies due to a poorly developed urinary system, possible manifestations of intoxication and an extended period of elimination of the active substance.
For diseases of the ENT organs, children are prescribed inhalations from a nebulizer to deliver the active substance to the bronchi and alveoli. Sessions last 15 minutes 2-5 times a day. Pneumonia requires complex treatment. Injections and inhalations of amikacin solution are used (with delivery of up to 70% of the active component to the alveoli and bronchi).
The drug acts quickly as an antibiotic (1 hour after administration). For children under 3 years of age, the dosage is precisely calculated by the doctor, since the amount may be reduced or limited.
The initial dosage for premature babies in injections should not be more than 10 mg/1 kg of weight. In case of kidney pathology, the initial dose is reduced and the interval between use increases.
The duration of administration of the medicine to children is at least 2 hours. Kidney function, creatinine and urea levels in the blood are carefully monitored by doctors during therapeutic actions. The course of therapy when administering medications into a vein is 3-7 days, intramuscularly - 7-10 days.
Fluditek for children: instructions and analogues
The antibiotic can be replaced with another analogue if it turns out to be ineffective when treated for 5 days in a row.
Use in elderly patients
Amikacin is prescribed to old people with caution, because when taken in large doses it can provoke a nephrotoxic and ototoxic effect. In particular, for kidney and liver diseases, myasthenia gravis, Parkinson's disease, the dosage is adjusted.
Features of the use of the medicine
Before use, this drug requires compliance with certain conditions and consideration of certain aspects.
The drug is administered in the form of injections. This is the only way it will have its healing effect.
If air gets into the syringe or the sterility of the process is compromised, the consequences can be very serious. Therefore, it is extremely important to administer the medicine correctly. It is better if this is carried out by a specially trained person in a hospital setting.
For small children, a 2 ml syringe is used, for all others - 5 ml.
The algorithm of actions when using Amikacin is as follows:
- The first step is to open the bottle of medicinal powder.
- Then add the required amount of water for injection, novocaine (or lidocaine), mix the components and draw the resulting solution using a syringe.
- If intravenous infusion is necessary, the powder should be dissolved in 200 ml of water for injection or saline.
- Wipe the puncture site with an antiseptic (in adults this is usually a vein on the elbow, in small children - on the outside of the hand).
- The drug is administered either intramuscularly, or intravenously (at a rate of about 1 drop per second), or intravenously (slowly injecting the entire amount of solution over two minutes).
Another feature that needs to be taken into account when using this antibiotic is its nephrotoxicity. Therefore, in patients with impaired renal function, it is extremely important to reduce the dose of the drug and administer it at longer intervals.
To find out the optimal length of such intervals, the patient must take a blood test to determine the concentration of creatinine in the serum. The result should be multiplied by 9. The resulting number will indicate the amount of time required (in hours).
When treating amikacin sulfate, it is important to consider its interaction with other drugs.
What and how to breed?
Amikacin is a white powder for injection. Diluted with distilled water - 1 bottle per 2-3 ml. It turns out a fresh ready-made portion. To be used immediately, without storing in the refrigerator.
To obtain a concentration of the active component of 5 mg/1 kg of body weight, instead of water for dilution, the following can be used:
- sodium chloride (0.09%);
- dextrose (5%);
- lidocaine, novocaine as excellent solvents and analgesics to reduce pain during injections.
To prepare an inhalation solution, a bottle (500 mg) of Amikacin is diluted with distilled water (3 ml), sodium chloride (solution, 0.9%). Lidocaine is not used due to a possible outbreak of complications in bronchopulmonary diseases.
Compound
The drug is a white powder of amikacin sulfate (in Latin - amikacini sulfatis).
To obtain the finished dosage form, it is necessary to dilute the substance with water for injection.
The procedure for administering the drug is quite painful, therefore, as an additional solvent, another 0.5% solution of novocaine or 2% solution of lidocaine is added to the water. These drugs act as pain-relieving components and alleviate the patient’s condition during injections.
Contraindications
Medicines from the aminoglycoside group are not prescribed in the following cases:
- excessive sensitivity to the active substance
- pregnancy, breastfeeding period
- acoustic neuritis
- renal failure, uremia, azotemia
- diseases of the vestibular apparatus, hematopoietic organs
- heart damage.
Reference! In case of obvious dehydration, Amikacin is prescribed with extreme caution. It cannot be used at all during pregnancy and breastfeeding by women due to the release of the active substance into milk and through the placenta with possible harm to the kidneys and hearing of the fetus.
Instructions:
Clinical and pharmacological group
06.015 (Antibiotic of the aminoglycoside group)
Release form, composition and packaging
The solution for intravenous and intramuscular administration is transparent, colorless or slightly colored.
| 1 ml | 1 amp. | |
| amikacin (as sulfate) | 250 mg | 500 mg |
Excipients: sodium disulfite (sodium metabisulfite), sodium citrate for injection (sodium citrate pentasesquihydrate), diluted sulfuric acid, water for injection.
2 ml - glass ampoules (5) - blister packs (1) - cardboard packs. 2 ml - glass ampoules (5) - blister packs (2) - cardboard packs. 2 ml - glass ampoules (10) - blister packs (1) - cardboard packs. 2 ml - glass ampoules (10) - cardboard boxes.
The solution for intravenous and intramuscular administration is transparent, colorless or slightly colored.
| 1 ml | 1 amp. | |
| amikacin (as sulfate) | 250 mg | 1 g |
Excipients: sodium disulfite (sodium metabisulfite), sodium citrate for injection (sodium citrate pentasesquihydrate), diluted sulfuric acid, water for injection.
4 ml - glass ampoules (5) - blister packs (1) - cardboard packs. 4 ml - glass ampoules (5) - blister packs (2) - cardboard packs. 4 ml - glass ampoules (10) - blister packs (1) - cardboard packs. 4 ml - glass ampoules (10) - cardboard boxes.
The powder for preparing a solution for intravenous and intramuscular administration is white or almost white, hygroscopic.
| 1 fl. | |
| amikacin (as sulfate) | 1 g |
Bottles with a capacity of 10 ml (1) - cardboard packs. Bottles with a capacity of 10 ml (5) - packs of cardboard. Bottles with a capacity of 10 ml (10) - packs of cardboard.
pharmachologic effect
A semi-synthetic broad-spectrum antibiotic from the group of aminoglycosides, has a bactericidal effect. By binding to the 30S subunit of ribosomes, it prevents the formation of a transport and messenger RNA complex, blocks protein synthesis, and also destroys the cytoplasmic membranes of bacteria.
Highly active against aerobic gram-negative microorganisms: Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Serratia spp., Providencia spp., Enterobacter spp., Salmonella spp., Shigella spp.; some gram-positive microorganisms: Staphylococcus spp. (including those resistant to penicillin and some cephalosporins).
Moderately active against Streptococcus spp.
When administered simultaneously with benzylpenicillin, it exhibits synergistic action against strains of Enterococcus faecalis.
Anaerobic microorganisms are resistant to the drug.
Amikacin does not lose activity under the influence of enzymes that inactivate other aminoglycosides, and may remain active against strains of Pseudomonas aeruginosa resistant to tobramycin, gentamicin and netilmicin.
Pharmacokinetics
Suction
After intramuscular administration, it is absorbed quickly and completely. Cmax in blood plasma with intramuscular administration at a dose of 7.5 mg/kg is 21 mcg/ml, after 30 minutes of intravenous infusion at a dose of 7.5 mg/kg is 38 mcg/ml. After IM administration, Tmax is about 1.5 hours.
The average therapeutic concentration with intravenous or intramuscular administration lasts for 10-12 hours.
Distribution
Plasma protein binding is 4-11%. Vd in adults - 0.26 l/kg, in children - 0.2-0.4 l/kg, in newborns: less than 1 week old and weighing less than 1500 g - up to 0.68 l/kg, less than 1 week old and weighing more than 1500 g - up to 0.58 l/kg, in patients with cystic fibrosis - 0.3-0.39 l/kg.
Well distributed in extracellular fluid (abscess contents, pleural effusion, ascitic, pericardial, synovial, lymphatic and peritoneal fluid); found in high concentrations in urine; in low levels - in bile, breast milk, aqueous humor of the eye, bronchial secretions, sputum and cerebrospinal fluid. Penetrates well into all tissues of the body, where it accumulates intracellularly; high concentrations are observed in organs with good blood supply: lungs, liver, myocardium, spleen, and especially in the kidneys, where they accumulate in the cortex; lower concentrations are found in muscles, adipose tissue and bones.
When administered in moderate therapeutic doses (normally) to adults, amikacin does not penetrate the BBB; with inflammation of the meninges, permeability increases slightly. Neonates achieve higher concentrations in the cerebrospinal fluid than adults. Penetrates the placental barrier: found in fetal blood and amniotic fluid.
Metabolism
Not metabolized.
Removal
T1/2 in adults - 2-4 hours, in newborns - 5-8 hours, in older children - 2.5-4 hours. Final T1/2 - more than 100 hours (release from intracellular depots).
It is excreted by the kidneys by glomerular filtration (65-94%), mainly unchanged. Renal clearance - 79-100 ml/min.
Pharmacokinetics in special clinical situations
T1/2 in adults with impaired renal function varies depending on the degree of impairment - up to 100 hours, in patients with cystic fibrosis - 1-2 hours, in patients with burns and hyperthermia T1/2 may be shorter than the average due to increased clearance .
It is eliminated by hemodialysis (50% in 4-6 hours), peritoneal dialysis is less effective (25% in 48-72 hours).
Dosage
The drug is administered intramuscularly, intravenously (in a stream, over 2 minutes or drip) to adults and children over 6 years old - 5 mg/kg every 8 hours or 7.5 mg/kg every 12 hours. For bacterial urinary tract infections ( uncomplicated) - 250 mg every 12 hours; after a hemodialysis session, an additional dose of 3-5 mg/kg may be prescribed.
Maximum doses for adults are 15 mg/kg/day, but not more than 1.5 g/day for 10 days. The duration of treatment with intravenous administration is 3-7 days, with intramuscular administration - 7-10 days.
For premature newborns, the initial single dose is 10 mg/kg, then 7.5 mg/kg every 18-24 hours; for newborns and children under 6 years of age, the initial dose is 10 mg/kg, then 7.5 mg/kg every 12 hours for 7-10 days.
For infected burns, a dose of 5-7.5 mg/kg every 4-6 hours may be required due to the shorter T1/2 (1-1.5 hours) in this category of patients.
Amikacin is administered intravenously over 30-60 minutes, or, if necessary, in a stream.
For intravenous administration (drops), the drug is pre-diluted with 200 ml of 5% dextrose (glucose) solution or 0.9% sodium chloride solution. The concentration of amikacin in the solution for intravenous administration should not exceed 5 mg/ml.
If renal excretory function is impaired, it is necessary to reduce the dose or increase the intervals between doses. In case of increasing the interval between administrations (if the CC value is unknown and the patient’s condition is stable), the interval between administration of the drug is set according to the following formula:
interval (h) = serum creatinine concentration × 9.
If the serum creatinine concentration is 2 mg/dL, then the recommended single dose (7.5 mg/kg) must be administered every 18 hours. When the interval increases, the single dose does not change.
In the case of a reduction in a single dose with an unchanged dosage regimen, the first dose for patients with renal failure is 7.5 mg/kg. Subsequent doses are calculated using the following formula:
Subsequent dose (mg) administered every 12 hours = patient's CL (ml/min) × initial dose (mg)/normal CL (ml/min).
Overdose
Symptoms: toxic reactions - hearing loss, ataxia, dizziness, urination disorders, thirst, loss of appetite, nausea, vomiting, ringing or a feeling of congestion in the ears, breathing problems.
Treatment: to relieve the blockade of neuromuscular transmission and its consequences - hemodialysis or peritoneal dialysis; anticholinesterase drugs, calcium salts, mechanical ventilation, other symptomatic and supportive therapy.
Drug interactions
Shows synergism when interacting with carbenicillin, benzylpenicillin, cephalosporins (in patients with severe chronic renal failure, when used together with beta-lactam antibiotics, the effectiveness of aminoglycosides may be reduced).
Nalidixic acid, polymyxin B, cisplatin and vancomycin increase the risk of oto- and nephrotoxicity.
Diuretics (especially furosemide), cephalosporins, penicillins, sulfonamides and NSAIDs, competing for active secretion in the nephron tubules, block the elimination of aminoglycosides, increase their concentration in the blood serum, increasing nephro- and neurotoxicity.
Amikacin enhances the muscle relaxant effect of curare-like drugs.
When used simultaneously with amikacin, methoxyflurane, polymyxins for parenteral administration, capreomycin and other drugs that block neuromuscular transmission (halogenated hydrocarbons - inhalation anesthesia, opioid analgesics), transfusion of large amounts of blood with citrate preservatives increase the risk of respiratory arrest.
Parenteral administration of indomethacin increases the risk of developing toxic effects of aminoglycosides (increased T1/2 and decreased clearance).
Amikacin reduces the effectiveness of antimyasthenic drugs.
Pharmaceutical interactions
Pharmaceutically incompatible with penicillins, heparin, cephalosporins, capreomycin, amphotericin B, hydrochlorothiazide, erythromycin, nitrofurantoin, vitamins B and C, potassium chloride.
Use during pregnancy and lactation
The drug is contraindicated during pregnancy.
If there are vital indications, the drug can be used in nursing women. It should be borne in mind that aminoglycosides are excreted in breast milk in small quantities. They are poorly absorbed from the gastrointestinal tract, and complications associated with them have not been recorded in infants.
Side effects
From the digestive system: nausea, vomiting, liver dysfunction (increased activity of liver transaminases, hyperbilirubinemia).
From the hematopoietic system: anemia, leukopenia, granulocytopenia, thrombocytopenia.
From the central nervous system and peripheral nervous system: headache, drowsiness, neurotoxic effect (muscle twitching, numbness, tingling, epileptic seizures), impaired neuromuscular transmission (respiratory arrest).
From the senses: ototoxicity (hearing loss, vestibular and labyrinthine disorders, irreversible deafness), toxic effects on the vestibular apparatus (discoordination of movements, dizziness, nausea, vomiting).
From the urinary system: nephrotoxicity - impaired renal function (oliguria, proteinuria, microhematuria).
Allergic reactions: skin rash, itching, skin hyperemia, fever, Quincke's edema.
Local reactions: pain at the injection site, dermatitis, phlebitis and periphlebitis (with intravenous administration).
Storage conditions and periods
List B. The drug should be stored out of the reach of children, in a dry place, protected from light at a temperature of 5° to 25°C. Shelf life: 2 years.
Indications
Infectious and inflammatory diseases caused by gram-negative microorganisms (resistant to gentamicin, sizomycin and kanamycin) or associations of gram-positive and gram-negative microorganisms:
- respiratory tract infections (bronchitis, pneumonia, pleural empyema, lung abscess);
- sepsis;
- septic endocarditis;
- CNS infections (including meningitis);
- abdominal infections (including peritonitis);
- genitourinary tract infections (pyelonephritis, cystitis, urethritis);
— purulent infections of the skin and soft tissues (including infected burns, infected ulcers and bedsores of various origins);
- biliary tract infections;
- infections of bones and joints (including osteomyelitis);
- wound infection;
- postoperative infections.
Contraindications
- neuritis of the auditory nerve;
- severe chronic renal failure with azotemia and uremia;
- pregnancy;
- hypersensitivity to the components of the drug;
- history of hypersensitivity to other aminoglycosides.
The drug should be used with caution in myasthenia gravis, parkinsonism, botulism (aminoglycosides can cause disruption of neuromuscular transmission, which leads to further weakening of skeletal muscles), dehydration, renal failure, in the neonatal period, in premature infants, in elderly patients, during lactation.
special instructions
Before use, the sensitivity of the isolated pathogens is determined using disks containing 30 μg of amikacin. With a diameter of the growth-free zone of 17 mm or more, the microorganism is considered sensitive, from 15 to 16 mm - moderately sensitive, less than 14 mm - resistant.
The concentration of amikacin in plasma should not exceed 25 mcg/ml (a concentration of 15-25 mcg/ml is therapeutic).
During the treatment period, it is necessary to monitor the function of the kidneys, auditory nerve and vestibular apparatus at least once a week.
The likelihood of developing nephrotoxicity is higher in patients with impaired renal function, as well as when prescribing high doses or for a long time (in these patients, daily monitoring of renal function may be required).
If audiometric tests are unsatisfactory, the dose of the drug is reduced or treatment is stopped.
Patients with infectious and inflammatory diseases of the urinary tract are recommended to take increased amounts of fluid with adequate diuresis.
In the absence of positive clinical dynamics, one should remember the possibility of the development of resistant microorganisms. In such cases, it is necessary to discontinue treatment and begin appropriate therapy.
The sodium disulfite contained in the drug can cause the development of allergic complications in patients (including anaphylactic reactions), especially in patients with an allergic history.
Use for renal impairment
Use is contraindicated in severe chronic renal failure with azotemia and uremia.
If renal excretory function is impaired, dosage regimen adjustment is required.
Conditions for dispensing from pharmacies
The drug is available with a prescription.
Side effects of Amikacin
The antibiotic has a nephrotoxic effect, so after administration it can cause:
- renal failure;
- urine discharge containing protein and blood particles;
- hearing loss, congestion in the ears with a negative effect on the hearing aid;
- irreversible deafness if the solution is injected in large doses;
- imbalance, coordination of movements;
- dizziness, headaches;
- hand tremors;
- dysbacteriosis;
- nausea;
- cardiopalmus;
- decreased blood pressure;
- paresthesia, muscle twitching
- allergic reactions on the body such as urticaria;
- fever;
- pain in the area of the inflamed vein.
Drug interactions
Amikacin is a strong antibiotic. Side effects when combined with various drugs and antibiotics (cephalosporins, Heparin, penicillins, Erythromycin) of other groups occur frequently:
- Combined use with loop diuretics (Furosemide) provokes a negative effect on the hearing aid.
- Combination with magnesium sulfate and inhalation anesthesia can cause increased neuromuscular blockade.
- When interacting with aminoglycosides, the antimicrobial effect of Amikacin decreases and the toxic effect increases.
- An enhanced nephrotoxic effect is observed when Amikacin is combined with Vancomycin, Amphotericin, Polymyxin, and nalidixic acid.
- The effectiveness of the drug is reduced when combined with Carbenicillin, Benzylpenicillin, cephalosporins (especially in patients with renal failure).
- There is a high probability of respiratory arrest if administered together with analgesics, homogenized hydrocarbons for inhalation (Methoxyflurane, polymyxins).
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Nephrotoxicity can occur when Amikacin is used in combination with many drugs: Amphotericin B, Vancomycin, Enflurane, Cyclosporine, Methoxyflurane. The antimicrobial effect is clearly reduced when combined with penicillins and the likelihood of respiratory depression increases in combination with ethyl alcohol and neuromuscular transmission blockers.
Amikacin is considered prohibited for mixing with ascorbic acid, tetracyclines, penicillins, cephalosporins, B vitamins, potassium chloride, Heparin, Thiopentone.
Use in pregnant and lactating women
"Amikacin" (in Latin - amikacinum) is strictly contraindicated for pregnant women at any stage of gestation. Under no circumstances should you use the drug while in this position. Otherwise, this can have an extremely negative impact on the formation and development of the fetus.
"Amikacin" (in Latin - amikacinum) belongs to category D among drugs that have an effect on the fetus. This means that its side effects have been proven and can cause significant damage to the health of the unborn child (impaired or absent hearing, pathologies of internal organs, and so on).
If there is an urgent need to use the medicine, then the nursing woman will have to decide on stopping lactation.
special instructions
- Amikacin is an ototoxic drug, which is important to consider when using it and not to deliberately increase the dosage.
- You should not administer the medicine for more than 2 weeks in a row, because safety has not been established.
- During treatment, it is important to monitor the functions of the vestibular apparatus, auditory nerve and kidneys at least once a week. Especially for patients with existing damage to these organs.
- After administration, dizziness may occur, which indicates a disorder of the vestibular system.
- If symptoms of deafness and inability to perceive high tones appear, you should consult a doctor. An audiometric test may be performed.
- In case of hearing loss, it is recommended to stop administering Amikacin and undergo an audiogram.
- Aminoglycoside antibiotics should not be used in high doses for parkinsonism or muscle disorders. Otherwise, increased muscle weakness may occur.
- If neuromuscular blockade occurs, doctors urgently turn on artificial ventilation and administer calcium salts.
- If respiratory arrest is acceptable, patients are given a transfusion of fresh citrated blood, anesthetic drugs, and muscle relaxants (Dexamethonium, Succinylcholine).
- In pediatrics, it is not recommended to use under 12 years of age. Also for adults when driving vehicles and working with dangerous mechanisms. Adverse reactions such as incoordination of movements, muscle twitching, drowsiness, headaches, dizziness, and migraines may develop.
Overdose
The drug has a systemic effect, affecting all human organs. Therefore, it is extremely important to follow the rules of use and dosage regimen. This will help avoid an overdose, which can lead to serious consequences. For example:
- blockade of nerves and muscles, complete cessation of breathing;
- depressed state of the central nervous system in the form of drowsiness, lethargy, stupor, falling into a coma.
If any of the listed symptoms appear, you should immediately seek medical help from a medical organization, where the overdose will be treated with intravenous administration of calcium chloride, subcutaneous - "NeosAmikacin" was in a place that is out of reach of children.
The shelf life of the drug is 2 years from the date of production. After this time, use of the drug is strictly prohibited.
An opened bottle should not be stored under any circumstances. One bottle - one use. And nothing else. Only under such conditions the sterility of the drug is not compromised.
What patients say
Amikacin has proven itself as an effective cure for infection in children. Parents are happy that the child feels better after the first injection (especially for intestinal disorders) or 2-3 inhalations for acute respiratory viral infections, acute respiratory infections.
Of course, the injections are painful and cause some discomfort. When giving injections, pediatricians recommend using Novocain for dilution instead of water. In general, Amikacin from the group of aminoglycosides is recognized as an effective antibiotic. The average cost in ampoules is 126-215 rubles. The drug is not available in tablets.
Analogs (briefly)
Analogues of Amikacin are:
- Selemicin. The active ingredient is amikacin. Available in the form of an injection solution. Can be prescribed for otitis media.
- Gentamicin (solution for injection). The drug is a 2nd generation aminoglycoside. Acts bactericidal. Can be prescribed for ventriculitis (inflammation of the ventricles of the heart), pyoderma and eye diseases (for drops and ointments).
- Netilmicin Protech. The active ingredient is netilmicin. The drug is a 3rd generation aminoglycoside. Contraindicated in children under 3 years of age.
- Amikacin-Ferein (solution, powder and lyophilisate). Indications are similar to Amikacin.
Instead of Amikacin, antibiotics of other groups (cephalosporins, fluoroquinolones) may be prescribed.
