Amikacin in Pregnancy and Breastfeeding

Risk Factor: C*
Class: Anti-infectives / Aminoglycosides

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Amikacin is an aminoglycoside antibiotic. The drug causes dose-related nephrotoxicity in pregnant rats and their fetuses (1). Reproduction studies have been conducted in mice and rats and no evidence of impaired fertility or teratogenicity was observed (2).

The drug rapidly crosses the placenta into the fetal circulation and amniotic fluid (3,4,5 and 6). Studies in patients undergoing elective abortions in the 1st and 2nd trimesters indicate that amikacin distributes to most fetal tissues except the brain and cerebrospinal fluid (3,5). The highest fetal concentrations were found in the kidneys and urine. At term, cord serum levels were one-half to one-third of maternal serum levels whereas measurable amniotic fluid levels did not appear until almost 5 hours after injection (4).

No reports linking the use of amikacin to congenital defects have been located. Ototoxicity, which is known to occur after amikacin therapy in humans, has not been reported as an effect of in utero exposure. However, eighth cranial nerve toxicity in the human fetus is well known after exposure to other aminoglycosides (see Kanamycin and Streptomycin) and could potentially occur with amikacin.

[*Risk Factor D according to manufacturers, Astra USA and Elkins-Sinn, 1998.]

Breast Feeding Summary

Amikacin is excreted into breast milk in low concentrations. After 100- and 200-mg IM doses, only traces of amikacin could be found for 6 hours in two of four patients (4,7). Because oral absorption of this antibiotic is poor, ototoxicity in the infant would not be expected. However, three potential problems exist for the nursing infant: modification of bowel flora, direct effects on the infant, and interference with the interpretation of culture results if a fever workup is required.

References

  1. Mallie JP, Coulon G, Billerey C, Faucourt A, Morin JP. In utero aminoglycosides-induced nephrotoxicity in rat neonates. Kidney Inter 1988;33:3644.
  2. Product information. Amikacin. Elkins-Sinn, 2000.
  3. Bernard B, Abate M, Ballard C, Wehrle P. Maternal-fetal pharmacology of BB-K8. Antimicrobial Agents and Chemotherapy 14th Annual Conference: Abstract 71, 1974.
  4. Matsuda C, Mori C, Maruno M, Shiwakura T. A study of amikacin in the obstetrics field. Jpn J Antibiot 1974;27:6336.
  5. Bernard B, Abate M, Thielen P, Attar H, Ballard C, Wehrle P. Maternal-fetal pharmacological activity of amikacin. J Infect Dis 1977;135:92531.
  6. Flores-Mercado F, Garcia-Mercado J, Estopier-Jauregin C, Galindo-Hernandez E, Diaz-Gonzalez C. Clinical pharmacology of amikacin sulphate: blood, urinary and tissue concentrations in the terminal stage of pregnancy. J Int Med Res 1977;5;2924.
  7. Yuasa M. A study of amikacin in obstetrics and gynecology. Jpn J Antibiot 1974;27;37781.

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Questions and Answers

can amikacin nebulization be used to treat pseudomonal chest infection?,

Yes, I believe it can be.
If you look this drug up on the internet, it says that you can use it for pneumonia.

This is about Disease Acute Pyogenic Meningitis with Pneumonia?, In this disease sometime hear loss of patient occur either due to disease itself or due to doses of Amikacin. What are chances of improvement. Can it be cured.

Both... there is a hearing loss with the meningitis because the infection from the meninges can affect the inner ear which is so close to the meningis.. so a hearing loss can occur.. and the drug amikacin is a ototoxic drug which means it itself can cause hearing loss on high doses but this is reversible when you stop the amikacin theraoy.. other ototoxic drugs are streptomycin, oflaxacin etc!

Be sure to give the injection in the anterior third of the snake so you are ahead of the kidney?, The vet was too busy to show me. I need to give Amikacin shots to my snakes and don't know where to do it. I don't want to mess this up! Please help!

I have given injections to snakes before. You will need a second person, one to hold the snake while the the other gives the injection. This injection will be in the muscle on either side of the spine in the third of the body behind the head(anterior third).
I would still contact the vet and ask to be shown how to give the shot.

Dehydration is a conern with this medication,so be sure to keep water avilibleat all times and it can help to soak your snake for about 20 minutes a day while giving the medication.

Pseudomonas aeruginosa treatment for open wound?, For a open wound with Pseudomonas aeruginosa
Suceptible to Imipenem & Amikacin
Lightly suceptible to Piperacillin
Resistant to all other antibiotics

The patient has been treated with Tazocin I.V. (Piperacillin)with no progress

Now my recomendation is Amikin (Amikacin) 1g every12h and Tienam (Imipenem) 500mg every 12h, both I.M. for at 7-10 days, the patient weight is about 50Kg (110pounds)
Is this ok?

there are several issues:
1. what kind of wound is this?
2. how was the culture taken?
3. how is the patient doing overall?
4. The amikacin dose is more than double the recommended one (huge even for normal renal function); imipenem may be enough depending on how severe the overall picture is
5. I would give them IV, not IM
6. debridement may be needed.

Please advice a medicin or help consultation?, Please give consultation. Is the report is good or something else.

REPORT OF URINE C/S
PATIENT : FEMALE
AGE : 65


CULTURE SHOWS THE GROWTH OF : ESCHERICHIA COLI.

VIABLE COUNT : MORE THAN 10/5 ML.

SENSITIVITY TEST

AMIKACIN SULPHATE : HIGHLY SENSITIVE

CIPROFLOXACIN : MODERATELY SENSITIVE

NORELOXACIN : HIGHLY SENSITIVE

GENTAMYCIN : HIGHLY SENSITIVE

GATIFLOXACIN : HIGHLY SENSITIVE

OFLOXACIN : HIGHLY SENSITIVE

CHLORAMPHENICOL : MODERATELY SENSITIVE

NALIDIXIC ACID : MODERATELY SENSITIVE

TERRAMYCIN : RESISTANT

CEFOTAXIME : HIGHLY SENSITIVE

CO-TRIMOXAZOLE : RESISTANT

CEPHALEXIN : RESISTANT

NITELMYCIN : HIGHLY SENSITIVE

DOXYCICLINE : RESISTANT

CLOXACILLIN : RESISTANT

AMOXYCILLIN : RESISTANT

AZITHROMYCIN : HIGHLY SENSITIVE

Use the Azithromycin, Use it exactly how the doctor says and for the amount of time he/she says. Start wiping from front to back!

what is the meaning of potentialdiuretics?, amikacin we can give together with lasix but contraindicated with potential diuretics whatis the meaning

When talking about a potential diuretic, you're referring to common drugs that have a side effects of dehydration or excessive urine output (e.g. caffeine, alcohol, amphetamines, ephedrine, etc.). These general diuretics act as a catalyst for the water in your system by being non-selective and just carry the water out through the kidneys. Lasix (furosemide) works selectively in the loop of henle inside of the kidney and, in turn, improves general kidney function.
Now to throw the amikacin into all of this (on top of what I'm just going make a good educated guess, and correct me if I'm wrong, is already some sort kidney dysfunction), it can be a bad situation since this drug comes with its own list of side-effects.
The "potential" diuretics are going to make the kidney work much, much harder which will cause the renal system to demand more oxygen. The kidney now releases the angiotensin converting enzyme (ACE). This is its way of telling the heart to work harder. So now you have just set yourself up for all sorts of heart issues which, if can be assumed or detected early enough, the patient can be put on an ACE inhibitor.
That, my friend, is your contraindication.

what does it mean "Esch Coli isolated" in a infant's stool culture report?, i have a 3 month old baby who's suffering from diarhhea like symptoms. A Paedetrician had advised me to get a stool culture test done. I did and the test report says

Org 1: Esch Coli Isolated

Antibiogram

SENSITIVE TO:

Imipenem
Amikacin
Piperacillin + Tazobactum

RESISTANT TO:

AMOXYCILLIN
AMPICILLIN
CEFAMANDOLE
CIPROFLOXACIN
CEFOTAXIME
CEFUROXIME
CEFAZOLIN...and many more medicines..I cant include all those...Please advise what does the report mean? I'm very much worried...

Thanks a lot

The Esch. coli harboured in the gut constitute a reservoir of potential pathogens in the infant and child. The conditions required for these intestinal inhabitants to cause infection are not well understood. The presence of virulence factors such as capsular antigens, especially K1, may be of significance for the ability of Esch. coli to cause neonatal meningitis. The capacity of certain Esch. coli to attach to epithelial cells of mucous membranes may be important for their infective powers in the urinary as well as the intestinal tract. Furthermore, the ability of certain Esch. coli to produce enterotoxins similar to that of V. cholerae is of importance for their capacity to provoke diarrhoea. The importance of the immune defence mechanisms for prevention of these Esch. coli infections is suggested, especially in the form of local immunity provided by secretory IgA antibodies. Such antibodies directed against Esch. coli O and K antigens as well as enterotoxins are present in large amounts in human milk and may be of considerable importance for protection against Esch. coli in the breast- fed baby. Breast feeding may be of special significance until the baby has built up its own local immune defence preventing the micro- organisms from attaching to and invading the intestinal mucous membranes. SIgA antibodies in urine may have a similar protective effect against urinary tract infections. The variable pictures of Esch. coli infections in childhood are striking, ranging from severe sepsis/meningitis or diarrhoea to "asymptomatic" bacteriuria. This variability is obviously closely connected with the presence of various virulence factors and the function of different components of the immune defence.
IN A NUT SHELL, E. COLI WAS FOUND IN YOUR CHILD'S STOOL SAMPLE,
ISOLATED CASE? MAYBE.....MEANING NO ONE ELSE IN THE HOUSE HAS IT?

my urine culture report shows me e-coli organisum from three months .i had several antibiotic and injection .?, like amikacin injection ,gatifloxin,azithromycin,oflox,zenflox, norflox but no relief . there is e-coli remain in urine test.sometime i feel fever when i checked there 98.8 tempreture.is it fever or not what i do please suggest me.

normal body temperature is 98.6

i wouldn't worry unless your temperature rises above 101.0

e-coli is a very strong bacteria and resistant to alot of antibiotics..it might take your doctor several of them to find one that works best to knock the bacteria out completely...

just continue to follow up with your dr and take all medication you are prescribed-if you stop taking the pills (b/c after a few of them you might feel better), the next time you get sick-the medicine will not work as well or not work at all so make sure to take all pills given.

Infant UTI?, We were in a small dilemma on one issue regarding Esha’s health and thought of writing to you. We would be grateful if you could kindly consult some good doctor on what line of action we should take.

During examination of Esha’s Urine Culture they have found the presence of E. Coli bacteria (100,000 organisms/ml – which is significant). However, in the Routine Urine test there is no indication of Pus cells. The test has been repeated a number of times and is showing the same result. Esha has had a couple of bouts of fever (upto 100.5 degrees) over the last one and a half months. We have also got the ultrasound of abdomen done, which is normal.
Now there are two clear views amongst the Peadiatricians here:

One doctor says that this must be treated for Urinary Tract Infection (UTI) by giving antibiotics as repeated tests have shown presence of E Coli.
Esha’s Urine Culture test shows that this bacteria is sensitive to Amikacin,
Cefoperazone+Sulbactum, Meropenem, Piperacillin+Tazobactum, and
Nitrofurantoin. These are all very strong antibiotics. They have suggested that the only antibiotic that can be given without hospitalization is Nitrofurantoin.

The other doctor has insisted that Esha has no symptoms of UTI and this is a case of Asymptomatic Bacteriuria. It should not be treated with antibiotics.
In fact if treated it increases the risk of symptomatic UTI at a later date.
This clearly puts us in a difficult choice.

We would be grateful if you could consult some good doctor and tell us about their thinking on this issue. The jury seems to be clearly divided.

There should not be e.coli in urine at all! Urine is naturally sterile. You need to start practicing better hygiene. Let me guess. This is a girl? Please, please, please start being more careful and practicing scrupulous hygiene in that area, or you are in for a serious situation. Be happy that (s)he is asymptomatic for now, hope that (s)he can get rid of the current e.coli infection using her own immune system, and don't let her get another infection.

kidney infection?, does anyone know if the iv antibotic (amikacin) is safe for me and my baby bcuz i was on it for about 3 days and i read about it and it said it can make the fetus deaf once its delivered so i got scared and told my doctor i want a diff kind, and then he cahnged it to invanz but i m still so worry about the amikacin

Call any pharmacist.