Amikacin Policy

Amikacin MUST only be used on microbiology advice

This dosing policy should not be used for the following - seek dosing advice from pharmacy:

  • Endocarditis
  • Pregnancy
  • Abnormal volume of distribution - e.g marked ascites
  • Major burns (> 20% surface area)
  • Febrile neutropenia
  • Meningitis

Amikacin Dosing Table

Use ACTUAL or MAXIMUM body weight if obese (>120% of IBW)- Use weight tables and charts below

CrCl (ml/min) Amikacin Dose
20-29 5.5mg/kg 24 hourly
30-49 6mg/kg 24 hourly
50-70 12mg/kg 24 hourly
>70 15mg/kg 24 hourly

Target Concentrations

CrCl (ml/min) Peak (1 hour post dose) Trough (pre-dose)
≥ 50 > 35mg/l < 2mg/l
<50 15-30 mg/l < 5mg/l

Sampling Guidelines

  • Check peaks (1 hour post dose) and trough (end of dosage interval) within the first 48 hours of therapy and repeat 2-3 days thereafter. If renal function rapidly changing, check more frequently.
  • Dose requirements will change if renal function alters - check creatinine concentration and eGFR on a daily basis.
  • Please record the exact times of all doses and samples on the request form and the sample times on the sample tubes.
  • Seek advice from pharmacy or microbiology if you are unsure how to interpret the result.


Ototoxicity can occur - the risk is greater in patients with renal impairment.  Symptoms include vestibular (nausea, dizziness, vertigo, nystagmus) and auditory toxicities (e.g ringing, fullness in the ears, decreased hearing).  Other risk factors include prolonged courses and concomitant nephrotoxic/ototoxic drugs. Consider audiometry testing in these patients.