Generic drug of the therapeutic class: Infectiology - Parasitology
active ingredients: Amikacin
laboratory: Bristol Myers Squibb
Powder and solvent for solution for IV infusion
They arise from the antibacterial activity and pharmacokinetic characteristics of amikacin. They take into account both the clinical studies that the drug has given and its place in the range of antibacterial products currently available.
- They are limited to infections with Gram-negative bacilli defined as sensitive, especially in their renal and urological manifestations.
- The combination of amikacin with another antibiotic may be justified in certain infections with sensitive germs based on bacteriological data, especially in their manifestations:
. renal, urological and genital
. septicemic and endocardial
. meningeal (with local treatment),
. cutaneous (staphylococcal malignant skin of the face),
- Official recommendations regarding the proper use of antibacterials should be taken into account.
Dosage AMIKLIN 1 g Powder and solvent for solution for infusion Box of 1 bottle of powder + 5 ml solvent ampoule
- slow intravenous infusion:
- AMIKACIN MUST NOT BE ADMINISTERED DIRECTLY.
- Amikacin should be diluted in a solution of sodium chloride or isotonic glucose at a rate of 500 mg per 200 ml of solution. The infusion should be administered for a period of one hour.
In intravenous infusion: amikacin is stable for 24 hours in the following solutions:
. isotonic saline solution at 0.9%,
. isotonic glucose solution at 5%,
. glucose solution at 10%.
ABOUT NORMAL RENAL FUNCTIONS :
- Adults and children:
15 mg / kg and per day can be divided into:
. 15 mg / kg, once a day,
. 7.5 mg / kg, twice daily,
. 5 mg / kg, three times a day.
Since the provision of aminoglycosides, it has been shown that it is possible for the same daily dosage to reduce the number of administrations. Conventionally, the number of injection was 3 per day, especially for the maximum doses, sometimes 2 per day. The experience gained indicates that in general the number of injection is 2 or even one per day.
- The daily dose can be administered as a daily injection ( IM or slow infusion ):
. in patients younger than 65,
. in patients with normal renal function,
. when the treatment does not exceed 10 days,
. in the absence of neutropenia,
. excluding Gram-positive infections,
. for Gram-negative infections, excluding Pseudomonas and Serratia .
- In these circumstances, at least an identical efficacy and a sometimes better tolerance have been demonstrated with a daily injection compared to the conventional modalities (q 8 hours).
- In other cases, twice daily administration of the usual dose is most often recommended, apart from renal insufficiency, which involves maintaining the usual measures.
- Plasma assays are useful when treatment should exceed 7 to 10 days; a residual concentration of less than 5 mcg / ml indicates that the chosen rate of administration is adapted to the patient's purification capacities.
In the case of extremely serious infection, the daily dose may exceptionally be increased to 1.50 g in adults, and the monitoring of renal and auditory functions must be reinforced.
In general, the total dose per treatment should not exceed 15 g.
IN THE INSUFFICIENT RENAL :
- Dosage adjustment, regular monitoring of renal, cochlear and vestibular function are essential, and serum control dosing should be performed as far as possible.
Serum creatinine or endogenous creatinine clearance values are the best tests to assess the status of renal function and to adjust the dosage.
- One of the methods proposed is to calculate the interval between the injections by taking into account the rate of serum creatinine which will have to be determined regularly during treatment in order to be able to adapt the dosage accurately to the variations of the renal function.
Practically, we will begin with a loading dose of 7.5 mg / kg which will be repeated, knowing that the interval of time T 'between each injection will be equal to 3 T1 / 2, the value of T1 / 2 being given by the relation:
T1 / 2 (hour) = 0.3 x Cr mg / L,
for example, for a serum creatinine at 40 mg / L, we will have:
T1 / 2 (hour) = 0.3 x 40 = 12 hours,
T '= 3 T 1/2 = 3 x 12 = 36 hours.
If T 'is greater than 40 hours, change the pattern and half dose every T1 / 2.
IN HEMODIALYSIS : After a loading dose of 5 to 7.5 mg / kg, determine the doses to be administered after each session, taking into account serum concentrations.
This medicine MUST NEVER BE USED in case:
- allergic to antibiotics of the aminoglycoside family,
- Simultaneous administration with other aminoglycosides (see interactions).
AMIKACIN MUST NOT BE DIRECTED INTRAVENOUSLY DIRECTLY.
NOT RECOMMENDED :
This medicine SHOULD NOT BE USED:
in combination with parenteral polymyxins (see interactions),
- in combination with botulinum toxin (see interactions),
- During pregnancy: The use of this drug is not recommended during pregnancy because of a potential risk of fetal ototoxicity and nephrotoxicity. Its use will be strictly limited to serious infectious diseases. Indeed, in clinical cases some cases of neonatal cochleovestibular involvement have been described with aminoglycosides, especially streptomycin and kanamycin, and animal studies have shown cochlear and renal involvement. In the case of exposure to this drug during pregnancy, an evaluation of the auditory (auto-emission) and renal function of the newborn is recommended.
Adverse effects Amiklin
this medicine belongs to the family of aminoglycosides for which cases of renal failure have been reported. Most of the time, they were related to too high dosage or prolonged treatment, previous renal damage, haemodynamic disorders, or combinations of products known to be nephrotoxic.
this drug belongs to the aminoglycoside family for which cases of cochleovestibular involvement have been reported. They were favored by too high a dosage, a long duration of treatment, a pre-existing renal insufficiency or by associations with ototoxic products.
- Minor allergic reactions (rash, urticaria) have been described. These phenomena stopped when the treatment was stopped.