should be monitored in patients receiving parenteral
aminoglycosides andmustbe determined in obesity, and in
cysticfibrois, or if high doses are being given, or if there is
renal impairment.
Neonates
As aminoglycosides are eliminated principally via the
kidney, neonatal treatment must reflect the changes in
glomerularfiltration that occur with increasing gestational
and postnatal age. Theextended interval dose regimenis used
in neonates, and serum-aminoglycoside concentrations
mustbe measured. In patients on single daily dose regimens
it may become necessary to prolong the dose interval to
more than 24 hours if the trough concentration is high.
Aminoglycosides (by injection) f
lCONTRA-INDICATIONSMyasthenia gravis (aminoglycosides
may impair neuromuscular transmission)
lCAUTIONSCare must be taken with dosage (the main side-
effects of the aminoglycosides are dose-related).
conditions characterised by muscular weakness
(aminoglycosides may impair neuromuscular
transmission).if possible, dehydration should be corrected
before starting an aminoglycoside.whenever possible,
parenteral treatment should not exceed 7 days
lSIDE-EFFECTS
▶Common or very commonHearing impairment
▶UncommonNausea.skin reactions.vomiting
▶Rare or very rareAnaemia.eosinophilia.fever.headache.
hypomagnesaemia.paraesthesia.renal impairment
▶Frequency not knownBronchospasm.confusion.lethargy.
nephrotoxicity
SIDE-EFFECTS, FURTHER INFORMATIONNephrotoxicity
occurs most commonly in children with renal failure.
lPREGNANCYThere is a risk of auditory or vestibular nerve
damage in the infant when aminoglycosides are used in
the second and third trimesters of pregnancy. The risk is
greatest with streptomycin. The risk is probably very small
with gentamicin and tobramycin, but their use should be
avoided unless essential.
MonitoringIf given during pregnancy, serum-
aminoglycoside concentration monitoring is essential.
lRENAL IMPAIRMENTExcretion of aminoglycosides is
principally via the kidney and accumulation occurs in renal
impairment. Ototoxicity and nephrotoxicity occur
commonly in patients with renal failure. A once-daily,
high-dose regimen of an aminoglycoside should be
avoided in children over 1 month of age with a creatinine
clearance less than 20 mL/minute/ 1. 73 m^2.
Dose adjustmentsIf there is impairment of renal function,
the interval between doses must be increased; if the renal
impairment is severe, the dose itself should be reduced as
well.
MonitoringSerum-aminoglycoside concentrationsmust
be monitored in patients with renal impairment; earlier
and more frequent measurement of aminoglycoside
concentration may be required.
lMONITORING REQUIREMENTS
▶Serum concentrationsSerum concentration monitoring
avoids both excessive and subtherapeutic concentrations
thus preventing toxicity and ensuring efficacy.
Serum-aminoglycoside concentrations should be
measured in all patients receiving parenteral
aminoglycosides andmustbe determined in obesity, if
high doses are being given and in cysticfibrosis.
Serum aminoglycoside concentrationsmustbe
determined in neonates.
In children with normal renal function, aminoglycoside
concentrations should be measured after 3 or 4 doses of a
multiple daily dose regimen.
Blood samples should be taken just before the next dose
is administered (‘trough’concentration). If the pre-dose
(‘trough’) concentration is high, the interval between
doses must be increased. For multiple daily dose regimens,
blood samples should also be taken approximately 1 hour
after intramuscular or intravenous administration (‘peak’
concentration). If the post-dose (‘peak’) concentration is
high, the dose must be decreased.
▶Renal function should be assessed before starting an
aminoglycoside and during treatment.
▶Auditory and vestibular function should also be monitored
during treatment.
eiiiiFaboveAmikacin
lINDICATIONS AND DOSE
Serious Gram-negative infections resistant to gentamicin
(multiple daily dose regimen)
▶BY SLOW INTRAVENOUS INJECTION
▶Child 1 month–11 years: 7. 5 mg/kg every 12 hours, to be
administered over 3 – 5 minutes
▶Child 12–17 years: 7. 5 mg/kg every 12 hours; increased to
7. 5 mg/kg every 8 hours (max. per dose 500 mg every
8 hours) for up to 10 days, higher dose to be used in
severe infection, to be administered over 3 – 5 minutes;
maximum 15 g per course
Serious Gram-negative infections resistant to gentamicin
(once daily dose regimen)
▶BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶Child:Initially 15 mg/kg adjusted according to plasma-
concentration monitoring, not to be used for
endocarditis or meningitis, dose to be adjusted
according to serum-amikacin concentration,
intravenous injection to be administered over
3 – 5 minutes
Neonatal sepsis (extended interval dose regimen)
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Neonate: 15 mg/kg every 24 hours, intravenous injection
to be administered over 3 – 5 minutes.Neonatal sepsis (multiple daily dose regimen)
▶BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶Neonate:Loading dose 10 mg/kg, then 7. 5 mg/kg every
12 hours, intravenous injection to be administered over
3 – 5 minutes.Pseudomonal lung infection in cystic fibrosis
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child: 10 mg/kg every 8 hours (max. per dose 500 mg
every 8 hours), intravenous injection to be
administered over 3 – 5 minutes
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, use ideal
weight for height to calculate dose and monitor serum-
amikacin concentration closelylUNLICENSED USEDose for cysticfibrosis not licensed.
lINTERACTIONS→Appendix 1 : aminoglycosides
lSIDE-EFFECTS
▶UncommonSuperinfection
▶Rare or very rareAlbuminuria.arthralgia.azotaemia.
balance impaired.hypotension.muscle twitching.tremor
▶Frequency not knownAcute kidney injury.apnoea.
neuromuscular blockade.paralysisBNFC 2018 – 2019 Bacterial infection 311
Infection5