Amikacin Sulfate

What is this medication for?

• Severe gram-negative infections (Klebsiella, Proteus, Pseudomonas, Salmonella, Enterobacter, Serratia, Staph) — including gentamicin-resistant Pseudomonas/Proteus/Serratia; sepsis

How is it given?

Give exactly as your veterinarian prescribed — never change the dose or stop on your own unless your veterinarian has told you to.

What if I miss a dose?

• Give it as soon as you remember — unless it is almost time for the next dose (then skip the missed one; never double up).
• Call your clinic if you miss more than one dose in a row.

Side effects — what should I watch for?

Effects listed as common in this handout

• Neuromuscular blockade (Myasthenia gravis exacerbation)
• Injection-site pain, hypersensitivity (Occasional)

Worth a phone call to your veterinarian

• Any new symptom that worries you.

⚠️ Contact your veterinarian or an emergency clinic IMMEDIATELY if you notice

• Nephrotoxicity (proximal tubular tissue death) (The class risk; usually reversible if caught (↑BUN/Cr, ↓USG, protein in the urine, casts))
• Ototoxicity (8th CN, may be irreversible) (Amikacin leans AUDITORY (vs gentamicin's vestibular))

Before starting (or refilling), tell your veterinarian if your pet:

• has or has had: Preexisting renal disease (extreme caution + monitoring + interval extension); neonatal/geriatric; dehydration, fever, sepsis; "working" dogs (hearing/service); sighthounds (reduce dose); myasthenia gravis
• has or has had: Contraindicated in rabbits (stomach/intestinal flora catastrophe)

• is pregnant, nursing, or used for breeding
• is taking any other medications, supplements, or flea/tick products, including:
  • Other kidney damage (amphotericin B, NSAIDs, cisplatin)
  • Loop diuretics (furosemide)
  • Beta-lactams
  • Neuromuscular blockers, anesthetics
  • Acepromazine/vasodilators

Storage and handling

Room temperature; do not mix in vitro with beta-lactams (inactivation — also space serum-sample draws away from beta-lactam peaks).

Good to know

• Once-daily dosing is the standard: higher peaks → concentration-dependent kill + post-antibiotic effect, and low troughs REDUCE kidney damage (less tubular uptake) — the one exception is the neutropenic patient (every 8 hours divided).
• Amikacin retains activity against many gentamicin-resistant gram-negatives — the go-to when susceptibility data point that way.
• Overdose rescue: hemodialysis (rarely available), peritoneal dialysis, or beta-lactam complexation (less effective for amikacin than gentamicin/tobramycin).
• Alkaline urine enhances activity — relevant for UTI use (alkalinize if needed).