Doses - AMIKACIN SULFATE

Note: There is significant interpatient variability with regards to aminoglycoside pharmacokinetic parameters. To insure therapeutic levels and to minimize the risks for toxicity development, it is recommended to consider monitoring serum levels for this drug.
For small animals, one pair of authors (Aronson and Aucoin 1989) make the following recommendations with regard to minimizing risks of toxicity yet maximizing efficacy:

1) Dose according to animal size. The larger the animal, the smaller the dose (on a mg/kg basis).

2) The more risk factors (age, fever, sepsis, renal disease, dehydration) the smaller the dose.

3) In old patients or those suspected of renal disease, increase dosing interval from q8h to q16-24h.

4) Determine serum creatinine prior to therapy and adjust by changes in level even if it remains in "normal range".

5) Monitor urine for changes in sediment (e.g., casts) or concentrating ability. Not very useful in patients with UTI.

6) Therapeutic drug monitoring is recommended when possible.

Dogs:

For susceptible infections:
a) 11 mg/kg IM or SQ q12h (Kirk 1989)
b) 5 - 10 mg/kg IV, IM or SubQ q8h (avoid use or reduce dosage in patients with renalfailure; recommend therapeutic drug monitoring, particularly in young animals) (Vadenand Papich 1995)
c) 5 mg/kg IV, or IM tid (Morgan 1988)
d) 10 mg/kg IM or SQ tid; soft tissue or skin infections should be treated for a minimumof 7 days and genitourinary infections treated for 7-21 days or until culture negative andasymptomatic. Do not exceed 30 days of treatment. (Package insert; Amiglyde - V®¯Fort Dodge)
e) In dogs with normal renal function: 10 mg/kg IM or SQ q8h for systemic infections, and q12h for UTI. (Baggot, Ling, and Chatfield 1985)
f) 8.8 - 17.6 mg/kg IV (only if acute sepsis), IM q8h (see adjustment guidelines above).(Aronson and Aucoin 1989)

Cats:

For susceptible infections:
a) 5 - 10 mg/kg IV, IM or SubQ q8h (avoid use or reduce dosage in patients with renalfailure; recommend therapeutic drug monitoring, particularly in young animals) (Vadenand Papich 1995)
b) 10 mg/kg SQ q8h (Jernigan, Wilson, and Hatch 1988)
c) 8.8 - 17.6 mg/kg IV (only if acute sepsis), IM q8h (see adjustment guidelines above).(Aronson and Aucoin 1989)

Cattle:

For susceptible infections:
a) 10 mg/kg IM q8h or 25 mg/kg q12h. (Beech 1987b)
b) 22 mg/kg/day IM divided tid (Upson 1988)

Horses:

For susceptible infections:
a) 6.6 mg/kg IM or IV tid (Robinson 1987)
b) For gram negative respiratory infections: 6.6 mg/kg IM or IV q4-6 h; IV use is recommended for bronchopneumonia. (Beech 1987a)
c) In foals: 7.5 mg/kg IV q12h; monitor serum levels if possible. (Caprile and Short 1987)
d) 4.4 - 6.6 mg/kg IV or IM bid - tid, tid if severe infection (serious life-threatening).(Orsini et al. 1985)
e) 4 - 8 mg/kg q8-12h IM (Baggot and Prescott 1987)
For uterine infusion:
a) 2 grams mixed with 200 ml sterile normal saline (0.9% sodium chloride for injection)and aseptically infused into uterus daily for 3 consecutive days. (Package insert;
Amiglyde-V®¯Fort Dodge)

Birds:

For susceptible infections:
a) For sunken eyes/sinusitis in macaws caused by susceptible bacteria: 40 mg/kg IM oncedaily or bid. Must also flush sinuses with saline mixed with appropriate antibiotic (10-30 ml per nostril). May require 2 weeks of treatment. (Karpinski and Clubb 1986)
b) 15 mg/kg IM or SubQ q12h (Hoeffer 1995)
c) For gram negative infections resistant to gentamicin: Dilute commercial solution andadminister 15-20 mg/kg (0.015 mg/g) IM once a day or twice a day. (Clubb 1986)

Reptiles:

For susceptible infections:
a) For snakes: 5 mg/kg IM (forebody) loading dose, then 2.5 mg/kg q72h for 7 - 9treatments. Commonly used in respiratory infections. Use a lower dose for Pythoncurtus. (Gauvin 1993)
b) Study done in gopher snakes: 5 mg/kg IM loading dose, then 2.5 mg/kg q72h. Housesnakes at high end of their preferred optimum ambient temperature. (Mader, Conzelman, and Baggot 1985)
c) For bacterial shell diseases in turtles: 10 mg/kg daily in water turtles, every other day inland turtles and tortoises for 7-10 days. Used commonly with a beta-lactam antibiotic.
Recommended to begin therapy with 20 ml/kg fluid injection. Maintain hydration andmonitor uric acid levels when possible. (Rosskopf 1986)
Monitoring Parameters -

1) Efficacy (cultures, clinical signs and symptoms associated with infection)

2) Renal toxicity; baseline urinalysis, serum creatinine/BUN. Casts in the urine are often theinitial sign of impending nephrotoxicity. Frequency of monitoring during therapy iscontroversial. It can be said that monitoring daily urinalyses early in the course oftreatment or daily creatinines once casts are seen or increases are noted in serum creatinine levels are not too frequent .

3) Gross monitoring of vestibular or auditory toxicity is recommended

4) Serum levels if possible; see the reference by Aronson and Aucoin in Ettinger (Aronsonand Aucoin 1989) for more information.
Client Information - With appropriate training, owners may give subcutaneous injections athome, but routine monitoring of therapy for efficacy and toxicity must still be done. Clients shouldalso understand that the potential exists for severe toxicity (nephrotoxicity, ototoxicity) developingfrom this medication.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products:
Amikacin Sulfate Injection 50 mg (of amikacin base) per ml in 50 ml vials; Amiglyde-V® (Fort
Dodge); Generic; (Rx) Approved for use in dogs.
Amikacin Sulfate Intrauterine Solution 250 mg (of amikacin base) per ml in 48 ml vials;
Amiglyde-V® (Fort Dodge); (Rx) Approved for use in horses.

Human-Approved Products:

Amikacin Injection 50 mg (of amikacin base) and 250 mg (of amikacin base) per ml; Amikin®(Apothecon); Generic (Rx)