An aminoglycoside antibiotic
Amikacin
A reserved aminoglycoside antibiotic given by injection for serious infections, often when other antibiotics are not suitable.
What is Amikacin?
Amikacin is an aminoglycoside antibiotic given by injection or infusion in hospital for serious infections caused by Gram-negative bacteria, often when other antibiotics have not worked. It is a reserved antibiotic because it can affect the kidneys and the hearing and balance organs. Blood levels and kidney function are monitored closely during treatment.
Education and reference only. This is a plain-language guide to Amikacin — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Amikacin is an aminoglycoside antibiotic used in hospital for serious infections, particularly those caused by Gram-negative bacteria. It is often kept in reserve for infections that are resistant to other aminoglycosides such as gentamicin, or where these have not worked. It is also used as part of treatment for some difficult infections, including certain unusual mycobacterial infections.
How it works
Amikacin gets inside bacteria and binds to their protein-making machinery (the ribosome), causing them to make faulty proteins. The faulty proteins damage the bacterial cell and stop it functioning, which kills the bacteria. The same machinery is structured differently in human cells, but the inner ear and kidneys are particularly sensitive to the drug, which explains its main risks.
Company & origin
Originated / developed by: Available as a generic medicine from several manufacturers..
An aminoglycoside developed in the 1970s, designed to stay active against bacteria resistant to earlier aminoglycosides such as gentamicin.
Practical use
How to take Amikacin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by a doctor, nurse or pharmacist into a vein or muscle, not by mouth.
- Treatment is kept as short as is safe to reduce the risk to the kidneys and ears.
- Blood samples are taken at set times so doses can be adjusted to keep levels safe and effective.
- Stay well hydrated unless your team advises otherwise, as this helps protect the kidneys.
- Report ringing in the ears, hearing or balance problems, or reduced urine output without delay.
- Tell your team about all other medicines, especially other antibiotics or water tablets.
Weighing it up
Advantages & disadvantages of Amikacin
Advantages
- Powerful activity against serious Gram-negative infections, including some resistant to other aminoglycosides.
- Useful as a reserved option when first-choice antibiotics have failed.
- Works well in combination with other antibiotics for difficult infections.
Disadvantages
- Can damage the kidneys and the hearing and balance organs, sometimes permanently.
- Needs careful blood-level monitoring, so it is largely a hospital medicine.
- Must be given by injection and is not suitable for everyone, including some people with muscle conditions.
Practical use
Good to know
Amikacin is given by a healthcare team into a vein or muscle, usually in hospital. Because it can harm the kidneys and the hearing and balance organs, blood levels are measured and kidney function is checked closely throughout treatment. Tell your team straight away about any ringing in the ears, hearing changes, dizziness or a drop in how much you are passing urine.
Who should not take it / use with caution
- People who have had a serious allergic reaction to amikacin or another aminoglycoside.
- People with myasthenia gravis, in whom it can worsen muscle weakness, unless there is no alternative.
- Use is generally avoided in pregnancy unless essential, because of a risk to the baby's hearing.
Monitoring
- Blood levels of amikacin, taken at set times to guide dosing.
- Kidney function before and regularly during treatment.
- Hearing and balance, especially with longer courses.
Side effects
- Effects on the kidneys, shown by blood tests.
- Ringing in the ears, hearing loss or balance problems, which can be lasting.
- Dizziness or unsteadiness.
- Rash or reactions at the injection site.
- Worsening muscle weakness in people prone to it.
Key interactions
- Other medicines that can harm the kidneys, such as certain antibiotics and water tablets.
- Other medicines that can affect hearing and balance, including some loop diuretics.
- Muscle relaxants used during surgery, whose effects it can prolong.
Available as: Injection/infusion (given into a vein or muscle).
Answers
Amikacin: frequently asked questions
Why is amikacin used only in hospital?
It is given by injection and needs blood-level and kidney monitoring to keep it safe, so it is normally used in hospital for serious infections.
Can amikacin damage my hearing?
Yes, aminoglycosides can affect the hearing and balance organs, sometimes permanently. Tell your team straight away about any ringing in the ears, hearing change or dizziness so treatment can be reviewed.
Why are blood tests taken during treatment?
Blood levels are measured to make sure there is enough antibiotic to clear the infection while keeping levels low enough to protect the kidneys and ears. Kidney function is also checked.
Is amikacin safe in pregnancy?
It is generally avoided in pregnancy unless there is no suitable alternative, because aminoglycosides can affect the baby's hearing. Your team will weigh up the benefits and risks.
Why is amikacin kept in reserve?
It stays active against some bacteria that resist other aminoglycosides, so keeping it for difficult or resistant infections helps preserve its usefulness.
The wider class
About Aminoglycosides
Amikacin belongs to the aminoglycosides class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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