Amikacin sulfate is stable for 24 hours at room temperature and 2 days at refrigeration at concentrations of 0.25 and 5.0 mg/mL in the following solutions:
5% Dextrose Injection, USP
5% Dextrose and 0.2% Sodium Chloride Injection, USP
5% Dextrose and 0.45% Sodium Chloride Injection, USP
0.9% Sodium Chloride Injection, USP
Lactated Ringer’s Injection, USP
Normosol®-M in 5% Dextrose Injection
Normosol®-R in 5% Dextrose Injection

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever the solution and container permit.

Aminoglycosides administered by any of the above routes should not be physically premixed with other drugs but should be administered separately.

Because of the potential toxicity of aminoglycosides, “fixed dosage” recommendations which are not based upon body weight are not advised. Rather, it is essential to calculate the dosage to fit the needs of each patient.


Therapeutic levels:
Peak:
Life-threatening infections: 25-30 mcg/mL
Serious infections: 20-25 mcg/mL
Urinary tract infections: 15-20 mcg/mL

Trough:
Serious infections: 1-4 mcg/mL
Life-threatening infections: 4-8 mcg/mL
Toxic concentration: Peak: >35 mcg/mL; Trough: >10 mcg/mL

Timing of serum samples: Draw peak 30 minutes after completion of 30-minute infusion or at 1 hour following initiation of infusion or I.M. injection; draw trough within 30 minutes prior to next dose 


Dosing interval in renal impairment: Some patients may require larger or more frequent doses if serum levels document the need (ie, cystic fibrosis or febrile granulocytopenic patients)

Clcr >/=60 mL/minute: Administer every 8 hours
Clcr 40-60 mL/minute: Administer every 12 hours
Clcr 20-40 mL/minute: Administer every 24 hours
Clcr<20 mL/minute: Loading dose, then monitor levels

Hemodialysis: Dialyzable (50% to 100%); administer dose postdialysis or administer 2 /3 normal dose as a supplemental dose postdialysis and follow levels

Peritoneal dialysis: Dose as Clcr<20 mL/minute: Follow levels

Continuous arteriovenous or venovenous hemodiafiltration effects: Dose as for Clcr 10-40 mL/minute and follow levels