阿米卡星
阿米卡星是一種強效的氨基糖苷類抗生素，主要用於治療嚴重的革蘭氏陰性菌感染、金黃色葡萄球菌及諾卡氏菌感染。它對於治療對慶大黴素等其他氨基糖苷類具有抗藥性的感染特別有價值。 **臨床警告**：此藥物穿透生物膜的能力較差，需要透過注射給藥，且在中樞神經系統和眼部積液中的濃度極低。使用時伴隨顯著的**腎毒性**和**耳毒性**風險。
作用機制: 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.
各物種劑量
- 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.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新藥品仿單及個別病患確認。
給藥途徑
禁忌症
- Animals with pre-existing reduced renal function (unless benefits outweigh risks)
- Dehydrated patients (without concurrent fluid therapy)
不良反應
- Nephrotoxicity (tubular necrosis)
- Ototoxicity (vestibular and auditory dysfunction)
- Neuromuscular blockade (rare but possible)
藥物相互作用
- 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
監測
- 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)
過量
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.
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用,不能取代專業判斷或廠方最新藥品說明書。