Medicinal Products

AMIKACINE MERCK 250 mg

Generic drug of the therapeutic class: Infectiology - Parasitology
active ingredients: Amikacin
laboratory: Generic Merck

Powder and solvent for solution for injection
Box of 20 vials of powder + 2 ml solvent ampoules
All forms

Indication

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.
In monotherapy, they are limited to Gram-negative bacilli infections defined as sensitive, especially in their renal and urological manifestations.
The combination of amikacin with another antibiotic may be justified in some infections with sensitive germs based on bacteriological data, particularly in their manifestations:
- renal, urological and genital
- septicemic and endocardial
- meningeal (with local treatment),
- respiratory,
- cutaneous (staphylococcal malignant skin of the face),
- articular.
Official recommendations concerning the appropriate use of antibacterials should be taken into account.
SPECTRUM OF BACTERIAL ACTIVITY:
- sensitive species:
. Gram-positive aerobes: Corynebacterium, Listeria monocytogenes, Nocardia asteroids, Staphylococcus méti -S.
. Gram-negative aerobes: Acinetobacter (mainly Acinetobacter baumannii ), Branhamella catarrhalis, Campylobacter, Citrobacter freundii, Citrobacter koseri, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Klebsiella, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia rettgerii, Providencia stuartii, Pseudomonas aeruginosa, Salmonella, Serratia, Shigella, Yersinia .
. others: Mycobacteria.
- moderately sensitive species (in vitro of intermediate sensitivity):
Gram-negative aerobes: Pasteurella .

Dosage AMIKACINE MERCK 250 mg Powder and solvent for solution for injection Box of 20 Vials of powder + ampoules of 2 ml solvent

Dosage:
ABOUT NORMAL RENAL FUNCTIONS :
Intramuscular route :
- Adults and children:
15 mg / kg / day which can be divided into:
. 15 mg / kg once a day,
. 7.5 mg / kg twice daily,
. 5 mg / kg three times daily.
- Infants:
15 mg / kg / day, under control of serum concentrations of the antibiotic.
In case of uncomplicated urinary tract infection, the dosage can be reduced by half.
Route IV (slow intravenous infusion) :
Amikacin should not be administered intravenously directly .
Amikacin should be diluted in a solution of sodium chloride or isotonic glucose at 500 mg per 200 ml of solution.
The infusion should be administered for a period of 30 minutes to 1 hour.
- Adults and children:
The daily dose is the same as when administered intramuscularly. It is also divided into 2 or 3 infusions.
- Infants and newborns:
15 mg / kg / day, under control of serum levels of the antibiotic.
Since the provision of aminoglycosides, it has been shown that it is possible, by 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 short infusion):
. in patients younger than 65,
. 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 sometimes better tolerance have been demonstrated with a daily injection compared to conventional modalities (every 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 μg / ml indicates that the chosen rate of administration is adapted to the patient's purification capacities.
- In the case of a very 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.
Subcutaneous route :
Amikacin can be administered subcutaneously at the same dosage as for the intramuscular route.
Intraspinal route :
Amikacin can be administered intratracheally at a dosage of 0.5 mg / kg, once every 48 hours, repeated 3-4 times after sterilization of the cerebrospinal fluid.
IN THE INSUFFICIENT RENAL :
- Dosage adjustment, regular monitoring of renal, cochlear, and vestibular function are essential, and serum control dosing should be performed as much 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.
- Practically, we will begin with a loading dose of 7.5 mg / kg which will be repeated, knowing that the time interval T 'between each injection will be equal to 3 T1 / 2, the value of T1 / 2 being given by the relation:
T 1/2 (hour) = 0.3 x Cr mg per thousand,
for example, for creatinine (Cr) at 40 mg per thousand, we will have:
T1 / 2 (hour) = 0.3 x 40 = 12 hours,
T '= 3 T1 / 2 = 3 x 12 = 36 hours.
If T 'is greater than 40 hours, change the pattern and make 1/2 every T1 / 2 dose.
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.
Administration mode :
Dissolve the contents of a 250 mg vial in the 2 ml ampoule of water for injections.
The reconstituted solution may have a slight yellow color which does not correspond to a loss of activity of the product.
Intravenous infusion :
The following solutions can be used at a rate of 500 mg per 200 ml of solution:
. isotonic sodium chloride solution at 0.9%.
. isotonic glucose solution at 5%.
. glucose solution at 10%.

Against indications

CONTRAINDICATED:
- This medicine should never be used in the following cases:
. allergy to antibiotics of the aminoglycoside family,
. gravis.
- Simultaneous administration of another aminoglycoside is contraindicated.
Amikacin should not be administered intravenously directly .
NOT RECOMMENDED :
- This drug is generally not recommended in combination with parenteral polymyxin or botulinum toxin (see section on interactions).
- 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 Amikacin Merck

- Nephrotoxicity: This drug belongs to the aminoglycoside family 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.
- Ototoxicity: 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.

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