[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Aminoglycosides](https://durgical.com/en/pharmacology/classes/aminoglycosides/) › Amikacin [Pharmacology](https://durgical.com/en/pharmacology/) · [Aminoglycosides](https://durgical.com/en/pharmacology/classes/aminoglycosides/) # Amikacin A semisynthetic aminoglycoside that resists most bacterial inactivating enzymes; used for resistant gram-negatives and mycobacteria. Updated 2026-11-01 - Class: [Aminoglycosides](https://durgical.com/en/pharmacology/classes/aminoglycosides/) - Target: Decoding (A) site of the bacterial 16S rRNA, 30S ribosomal subunit - ATC code: J01GB06 - WHO Model List of Essential Medicines ◆**Decoding (A) site of the bacterial 16S rRNA, 30S ribosomal subunit**Amikacin ⓘ The figure shows amikacin bound to a short RNA that reproduces the bacterial decoding site, not a whole ribosome. **Target in 3D:** Decoding (A) site of the bacterial 16S rRNA, 30S ribosomal subunit. PDB structure 4P20 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/4P20) · Drag to rotate · pinch to zoom ## Mechanism of action Like gentamicin, amikacin binds the decoding site of the 30S subunit and makes the ribosome misread mRNA. It is a derivative of kanamycin with a side chain that protects it from most aminoglycoside-modifying enzymes, so strains resistant to gentamicin and tobramycin often remain susceptible. - Enters the bacterium; its side chain shields it from modifying enzymes - Binds the 16S rRNA A site of the 30S subunit - mRNA misreading produces faulty proteins - Rapid bactericidal effect ## Pharmacokinetics **Absorption** Given intravenously or intramuscularly; not absorbed by mouth. **Distribution** Extracellular fluid; protein binding is very low; it crosses the placenta and reaches the cerebrospinal fluid better when the meninges are inflamed. **Elimination** Unchanged in the urine by glomerular filtration. **Half-life** Slightly over 2 hours in adults with normal kidney function; longer in newborns and in kidney failure. ## Indications - Serious infections by gram-negative bacilli resistant to gentamicin or tobramycin, including Pseudomonas. [MRSA and other multidrug-resistant organism infections →](https://durgical.com/en/conditions/mrsa-and-other-multidrug-resistant-organism-infections/) - Bacterial septicemia, including neonatal sepsis. [Neonatal sepsis →](https://durgical.com/en/conditions/neonatal-sepsis/) - Intra-abdominal infections such as peritonitis (with an anti-anaerobe drug). [Peritonitis →](https://durgical.com/en/conditions/peritonitis/) - Part of combination regimens for mycobacterial infections, including tuberculosis. [Tuberculosis →](https://durgical.com/en/conditions/tuberculosis/) ## Adverse effects ### Common - Hearing loss starting at high frequencies, tinnitus - Rising creatinine and less urine - Rash, fever, headache, paresthesia ### Serious (rare, important) - Irreversible cochlear damage; amikacin affects hearing more than balance - Acute kidney injury - Neuromuscular blockade and respiratory paralysis - Clostridioides difficile diarrhoea ## Contraindications - Hypersensitivity to amikacin - History of hypersensitivity or serious toxicity with another aminoglycoside ## Key interactions **Loop diuretics** More ototoxicity. **Other nephrotoxic or neurotoxic drugs (vancomycin, polymyxins, cisplatin, other aminoglycosides)** Added kidney and nerve damage. **Anaesthetics and neuromuscular blockers** Risk of prolonged paralysis and apnea. **β-lactams in the same solution** Mutual inactivation; given separately. ## What is monitored - Peak and trough levels by protocol - Creatinine and urine output - Audiometry, especially in long mycobacterial treatments ## Administration and safety - Intravenous infusion or intramuscular injection; not mixed with β-lactams in the same container. - Look-alike risk with other aminoglycosides and with similar-sounding names: check the drug name on every vial. - Level samples at the times the protocol sets. ## Nursing care - Baseline creatinine, weight and hearing assessment before long courses. - Hydration and intake–output record. - Ask about tinnitus or muffled hearing at each shift; high-frequency loss may go unnoticed by the patient. - Teaching: report ringing, hearing change, dizziness, numbness or diarrhoea. ## Pregnancy and breastfeeding Amikacin crosses the placenta into the amniotic fluid; aminoglycosides can cause fetal harm, including deafness, so it is used only when the benefit justifies it. ## Memory aid AMIKACIN wears «armour»: its side chain shields it from the enzymes that disarm gentamicin, but the armour does not protect the patient's ears. ## Test yourself Think of the answer, then tap the question to see it. ## Why does amikacin often work against gram-negatives resistant to gentamicin? Its side chain makes it a poor substrate for most aminoglycoside-modifying enzymes, the commonest resistance mechanism. ## Which ear function does amikacin damage most? Hearing (cochlear damage, starting at high frequencies), more than balance. ## Besides resistant gram-negatives, which infections is amikacin used for? Mycobacterial infections, including tuberculosis, always within combination regimens. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/amikacin/) ## Related drugs - [Gentamicin](https://durgical.com/en/pharmacology/gentamicin/) - [Tobramycin](https://durgical.com/en/pharmacology/tobramycin/) - [Streptomycin](https://durgical.com/en/pharmacology/streptomycin/) - [Linezolid](https://durgical.com/en/pharmacology/linezolid/) ## Related conditions - [MRSA and other multidrug-resistant organism infections](https://durgical.com/en/conditions/mrsa-and-other-multidrug-resistant-organism-infections/) - [Neonatal sepsis](https://durgical.com/en/conditions/neonatal-sepsis/) - [Peritonitis](https://durgical.com/en/conditions/peritonitis/) - [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/) [← Back to the class: Aminoglycosides](https://durgical.com/en/pharmacology/classes/aminoglycosides/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - AMIKACIN SULFATE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890) (DailyMed (U.S. National Library of Medicine), 2026); [Amikacin Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682661.html) (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 59 (McGraw Hill, 2023); [RCSB PDB - 4P20: Crystal structures of the bacterial ribosomal decoding site complexed with amikacin](https://www.rcsb.org/structure/4P20) (RCSB Protein Data Bank, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/amikacin/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/amikacin/