Amikacin
Amikacin is a potent aminoglycoside antibiotic primarily active against severe Gram-negative bacterial infections, *Staphylococcus aureus*, and *Nocardia* spp. It is particularly valuable for treating infections resistant to other aminoglycosides like gentamicin. **Clinical Pearl:** Streptococci and anaerobic bacteria are typically resistant. Activity is significantly reduced in low-oxygen environments (e.g., abscesses, necrotic tissue). > **Warning:** Amikacin has poor penetration across biological membranes; systemic levels require parenteral administration, and it achieves very limited concentrations in the CNS and ocular fluids. It carries significant risks of **nephrotoxicity** and **ototoxicity**.
Mecanismo: Aminoglycosides irreversibly bind to the **30S ribosomal subunit** of susceptible bacteria, inhibiting bacterial protein synthesis. They exhibit **concentration-dependent killing** → leading to a marked **post-antibiotic effect** (PAE). This allows for prolonged dosing intervals (e.g., q24h), which maximizes bacterial kill rates while minimizing accumulation in renal tubular cells, thereby reducing toxicity.
Dosificación por especie
- Susceptible bacterial infections · 15-30 mg/kg · IV/IM/SC · q24h · Not specified · IV doses should be given slowly over 30-60 minutes.
- Susceptible bacterial infections in Greyhounds and sight hounds · 12 mg/kg · IV/IM/SC · q24h · Not specified · Lower dose recommended due to a lower volume of distribution in these breeds.
- Sepsis · Higher than standard doses · IV/IM/SC · q24h · Not specified · Recommended by some authors, but carries an increased risk of adverse effects.
- Local infections (e.g., joints, bladder) · Varies · topical · Varies · Not specified · Considered if the site is easily accessible and if the animal shows signs of systemic nephrotoxicity.
- Susceptible bacterial infections · 10-15 mg/kg · IV/IM/SC · q24h · Not specified · IV doses should be given slowly over 30-60 minutes.
- Sepsis · Higher than standard doses · IV/IM/SC · q24h · Not specified · Recommended by some authors, but carries an increased risk of adverse effects.
- Local infections (e.g., joints, bladder) · Varies · topical · Varies · Not specified · Considered if the site is easily accessible and if the animal shows signs of systemic nephrotoxicity.
Las dosis son una referencia clínica para médicos veterinarios. Confirme siempre con la información vigente del producto y el paciente individual.
Vías de administración
Contraindicaciones
- Animals with pre-existing reduced renal function (unless benefits outweigh risks)
- Dehydrated patients (without concurrent fluid therapy)
Efectos adversos
- Nephrotoxicity (tubular necrosis)
- Ototoxicity (vestibular and auditory dysfunction)
- Neuromuscular blockade (rare but possible)
Interacciones farmacológicas
- Beta-lactam antimicrobials (Penicillins, Cephalosporins) · In vivo synergism against susceptible bacteria; however, they can cause in vitro inactivation of amikacin. Do not mix in the same syringe. · moderate
- Amphotericin B · Increased risk of severe nephrotoxicity. · major
- Furosemide · Increased risk of ototoxicity and nephrotoxicity. · major
- Heparin · In vitro inactivation of amikacin. Do not mix in the same syringe. · moderate
- Neuromuscular blocking agents · Potentiation of neuromuscular blockade. · major
Monitoreo
- Serum amikacin levels (peak for efficacy, trough for toxicity)
- Renal function (BUN, serum creatinine, urinalysis for casts/proteinuria)
- Hydration status
- Auditory and vestibular function (if possible)
Sobredosis
Overdosage significantly increases the risk of **acute tubular necrosis (nephrotoxicity)** and **vestibular/auditory damage (ototoxicity)**. Treatment is supportive. Discontinue the drug immediately and initiate aggressive intravenous fluid therapy to promote diuresis and maintain glomerular filtration rate.
La referencia de fármacos de VetSheet está destinada a médicos veterinarios como apoyo a la decisión clínica; no sustituye el juicio profesional ni la información vigente del fabricante.