Amikacin: what it treats, how it is given, and side effects
Last updated September 7, 2026.
**Amikacin is an aminoglycoside antibiotic given by injection into a vein or muscle for serious bacterial infections.** It binds to the bacterial ribosome and blocks the bacteria from making the proteins they need to survive, which kills them rather than just slowing their growth. It is reserved for infections that need a strong intravenous drug, usually gram-negative bacteria such as Pseudomonas, E. coli, Klebsiella, Enterobacter, Serratia, and Acinetobacter. The safety point that drives every decision about amikacin is that it can damage the kidneys and the hearing and balance nerve, so blood levels, kidney function, and hearing are watched during treatment and the course is kept as short as the infection allows.
What does it treat?
Amikacin is used in the hospital or in supervised home infusion for serious infections caused by gram-negative bacteria, including bloodstream infections and sepsis, hospital-acquired and ventilator-associated pneumonia, complicated urinary tract infections and kidney infections that have not responded to oral antibiotics, intra-abdominal infections such as peritonitis, bone and joint infections, burn and postoperative wound infections, and infections of the central nervous system in specific situations. It is often chosen when a culture shows an organism resistant to gentamicin or tobramycin, since amikacin holds up against many bacteria that inactivate the older aminoglycosides. It is also used as part of multi-drug treatment for some mycobacterial infections, including drug-resistant tuberculosis. Doctors usually pair it with a second antibiotic such as a penicillin or cephalosporin, because amikacin does not cover anaerobes and covers streptococci and staphylococci poorly on its own. There are no fixed-dose combination products containing amikacin; the separate inhaled liposomal form is a different product used for lung disease caused by Mycobacterium avium complex and is not interchangeable with the injection.
How do you take it?
Amikacin comes as a sulfate solution in vials for intramuscular injection or for intravenous infusion, usually run in over 30 to 60 minutes in adults, and it is always given by a health professional rather than self-administered as a pill. The usual adult and pediatric dose in people with normal kidney function is 15 mg/kg a day, split into two doses of 7.5 mg/kg every 12 hours or three doses of 5 mg/kg every 8 hours, and the total daily dose must not go above 1.5 g. Uncomplicated urinary tract infection is treated with a smaller dose of 250 mg twice a day. Dosing is based on body weight, and obese patients are dosed on an adjusted weight rather than total weight. Treatment normally runs 7 to 10 days, and the whole course is generally kept under 15 g in total. If your kidneys are not working normally, the dose is lowered or the interval between doses is stretched based on your creatinine and measured blood levels; target peaks are about 20 to 30 mcg/mL, and your team will act on peaks above 35 mcg/mL or troughs above 10 mcg/mL. Food and drink do not affect an injected antibiotic, so there are no meal rules, though staying well hydrated helps protect the kidneys. There is no home missed-dose rule to follow: if an infusion time is missed or delayed, call your infusion nurse or clinic and let them reset the schedule, and never give two doses close together to catch up. Call your care team the same day and ask whether to hold the next dose if you notice ringing or fullness in your ears, any drop in hearing, spinning or unsteadiness, much less urine than usual, new swelling, or a rash.
Side effects to know
- Common: Many people get through a short course with no clear side effects, and the ones most often reported are mild and short-lived: pain or redness at the injection site, nausea, headache, drug fever, and a rash.
- Serious: Stop the next dose and get medical help right away for hearing loss, ringing or roaring in the ears, or new spinning, unsteadiness, or vertigo, and for signs of kidney injury such as passing much less urine, foamy or bloody urine, or sudden swelling of the legs and face, since ear damage can become permanent if the drug continues. Get emergency help for a severe allergic reaction with hives, swelling of the lips, tongue, or throat, or trouble breathing, and for sudden muscle weakness or shallow breathing, which can happen when amikacin blocks nerve signals to the muscles.
Who should not take it?
Amikacin should not be used if you have had a serious allergic reaction to it or to another aminoglycoside such as gentamicin, tobramycin, streptomycin, neomycin, or kanamycin, because cross-reaction is common. Tell your doctor if you have kidney disease or are on dialysis, any existing hearing loss, tinnitus, or balance problems, myasthenia gravis or Parkinson disease, low magnesium, potassium, or calcium, or if you are dehydrated, since all of these raise the risk of harm and change the dose. The risk goes up when amikacin is combined with other drugs that stress the kidneys or the ears, including cisplatin, amphotericin B, cyclosporine, vancomycin, polymyxins, cephalosporins, and NSAIDs, and with potent diuretics such as furosemide and ethacrynic acid; muscle relaxants used in surgery and large transfusions of citrated blood can add to the muscle weakness effect. Amikacin crosses the placenta and can cause irreversible deafness in the baby when aminoglycosides are given during pregnancy, so it is used in pregnancy only when the infection is serious enough that no safer option will work; tell your clinician if you are pregnant or might be. Small amounts pass into breast milk and are poorly absorbed by the infant, and breastfeeding is usually considered acceptable during treatment, but confirm the plan with your own clinician. Alcohol does not interact directly with amikacin, though heavy drinking leaves you dehydrated and makes dizziness and kidney strain harder to read, so it is better to skip it during the course.
When is it an emergency?
Call 911 if you collapse, have trouble breathing, or develop swelling of the face, lips, or tongue, widespread hives, or lightheadedness during or shortly after an infusion, since that pattern points to anaphylaxis. Call 911 as well for sudden severe muscle weakness or breathing that feels shallow or hard to keep going, which can follow a dose given too fast or given with muscle relaxants. Sudden hearing loss, loud ringing, or violent spinning is urgent even without other symptoms: hold the next dose and reach your care team or an emergency department the same day. Almost stopping urine output, or severe vomiting and confusion in someone on amikacin, also needs same-day in-person care. For a suspected overdose or a dose given in error, call Poison Control at 1-800-222-1222 right away, and call 911 if the person is unresponsive or struggling to breathe; hemodialysis can remove amikacin from the blood, so getting to a hospital quickly matters.
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Common questions
What is the maximum dose of amikacin in a day?
For adults with normal kidney function the usual dose is 15 mg/kg a day, and the total daily dose must not go above 1.5 g no matter what your weight is. That daily amount is split into 7.5 mg/kg every 12 hours or 5 mg/kg every 8 hours. A course is normally 7 to 10 days and the total for the whole course is generally kept under 15 g. If your kidneys are impaired, your dose is reduced or spaced further apart based on your creatinine and on measured blood levels, so your personal ceiling may be well below the standard one.
Can I drink alcohol while I am on amikacin?
Alcohol does not react with amikacin the way it does with metronidazole, so a drink will not make you violently ill. The practical problem is that alcohol dehydrates you, and dehydration is one of the clearest risk factors for amikacin damaging the kidneys. Alcohol also causes dizziness and unsteadiness, which are the exact symptoms your team is watching for as early signs of inner ear injury. Skip alcohol during the course so that any new dizziness is a real signal and not noise, and keep drinking water and other fluids instead.
Is amikacin safe in pregnancy or while breastfeeding?
Amikacin crosses the placenta, and aminoglycosides given during pregnancy have caused permanent deafness in babies exposed in the womb. Because of that, it is used in pregnancy only when the infection is serious and no safer antibiotic will treat it, and the decision is made case by case with your obstetrician. Tell your clinician before the first dose if you are pregnant or think you might be. For breastfeeding, only small amounts reach the milk and a baby's gut absorbs almost none of it, so nursing is usually considered acceptable during treatment, but confirm with your own clinician and watch the baby for diarrhea or thrush.
Do I need to take amikacin with food?
No. Amikacin is given into a vein or a muscle, not by mouth, so food has nothing to do with how much drug reaches your blood. Eat normally on your usual schedule. The one thing worth being deliberate about is fluid: staying well hydrated helps your kidneys clear the drug and lowers the chance of kidney injury, so drink water steadily through the day unless your doctor has restricted your fluids for another reason.
What are the signs that I am getting too much amikacin?
The earliest warning is usually in the ears: ringing, roaring, a feeling of fullness, trouble following conversation, or new spinning and unsteadiness. Kidney signs come next, including passing much less urine than usual, urine that looks foamy, and swelling in the legs, hands, or face. High levels can also cause numbness, tingling, muscle twitching, or clear muscle weakness, and in a large overdose given quickly the breathing muscles can weaken. Report any of these the same day, and for a known overdose or a wrong dose call Poison Control at 1-800-222-1222; hemodialysis can pull amikacin out of the blood if needed.
Which other medicines cause problems with amikacin?
The biggest issues are other drugs that hurt the kidneys or the hearing nerve, because the effects stack. That list includes cisplatin, amphotericin B, cyclosporine, vancomycin, polymyxin B and colistin, some cephalosporins, and regular NSAIDs such as ibuprofen and naproxen. Potent diuretics such as furosemide and ethacrynic acid raise the risk of hearing loss, especially given intravenously. Anesthetics and muscle relaxants used in surgery, and massive transfusions of citrated blood, can combine with amikacin to cause muscle weakness and breathing trouble. Give your team a full list of everything you take, including over the counter pain relievers and supplements, before the first dose.