Amikacin for inhalation

Amikacin is an antibiotic called an aminoglycoside and commonly given by inhalation. As there is no inhalation solution available, the injection form is nebulised into a fine mist that is breathed into the lungs. It is also given as an injection.

It is used to treat lung infections caused by non-tuberculosis mycobacterium (NTM) in people with Cystic Fibrosis (CF) or bronchiectasis (lung damage causing mucus to build up).

The brand of amikacin used for inhalation must be the DBL Amikacin Injection® which is preservative free (500 mg per 2 mL). Ask your pharmacist if you have any questions and let them know if you are given a different brand.

While using amikacin – Remember

• Use the DBL Amikacin Injection® for inhalation. A specific nebuliser is required.
• Prepare each dose immediately before use, do not keep any unused solution.
• Discard unused solution and amikacin vials into a Sharps container. Return full Sharps container to your local pharmacy or hospital pharmacy/ CF clinic for disposal. Do not throw in the general rubbish.
• If the amikacin causes wheezing or chest tightness on inhalation, talk to your doctor or CF nurse.
• If you or your child is breastfeeding, pregnant or wishes to become pregnant, speak to your doctor or pharmacist about what precautions are needed.

Giving my child inhaled amikacin

The usual dose of inhaled amikacin is 500 mg twice a day. Your doctor will let you know if a different dose is required and how long to continue.

The length of treatment will depend on how quickly the infection is cleared from the lungs.

When and how should I give inhaled amikacin?

Inhaled amikacin doses should be given twice a day, at least 8 hours apart via a specific nebuliser.

Give the first dose in the morning and second dose in the afternoon or night around the same times each day so it becomes part of your routine. (e.g. 8 am and 8 pm)

Amikacin is best inhaled after salbutamol (e.g. Ventolin®, Asmol®) and chest physiotherapy (if you are performing chest physiotherapy). Wait until coughing has settled before inhaling the amikacin so it stays in the lungs as long as possible.

Give the salbutamol through a spacer or nebuliser. If the salbutamol was given up to 4 hours before the amikacin, it does not need to be repeated.

Preparing amikacin for inhalation

• Prepare each dose immediately before use – do not keep any unused solution.
• Use a new syringe and needle each time.
• Use a specific nebulising bowl just for amikacin. Do not mix amikacin with other inhaled medicines such as ipratropium [Atrovent®], dornase [Pulmozyme®] or hypertonic saline [HyperSal®].
• Wash hands before and after preparing with soap and water. Dry with clean cloth.

Step 1

• Withdraw the amount needed for your child’s dose from the amikacin vial using the needle on the syringe.
• For a 500 mg dose, withdraw all the contents of one vial (2 mL).
• Use same syringe and needle to withdraw 2 mL from sodium chloride 0.9% ampoule. Remove the syringe from sodium chloride 0.9% ampoule.
• The syringe contains 4 mL (2 mL of amikacin (500 mg/ 2mL) plus 2 mL of sodium chloride 0.9%).
• Draw air into the syringe by pulling back on the plunger. Gently rotate syringe, side to side, mixing the solution.
• Discard the needle and amikacin vial in the Sharps container provided.

Step 2

• Gently empty the solution from the syringe (4 mL) into your amikacin nebuliser bowl and replace the lid.
• For children under 4 years of age, use a mask. For older children, use the mouthpiece recommended by your nurse.
• Start the nebuliser, encourage your child to breath normally until the medication stops ‘misting’. Always nebulise in a well-ventilated area (near an open window).

Step 3

• Discard remaining rubbish (plastic sodium chloride 0.9% ampoule and syringe) in household bin. Do not re-use due to the risk of infection.
• Wash the nebulising bowl after each use with warm soapy water and rinse. Air dry on a clean surface. The bowl can be placed in the dishwasher on a clean wash (without dirty dishes) at 50 ºC or greater.
• Wipe down preparation area and wash hands with soapy water when finished.

What to do if a dose is missed

If you miss a dose, skip that dose and give the next dose at the normal time. Do not wake your child to give a missed dose.

What to do if I give too much amikacin

If you think your child has had too much amikacin or taken it in a different way, call the Poisons Information Centre on 13 11 26 even if your child shows no effects.

In an emergency, call Triple Zero (000) for an Ambulance or take your child to hospital straight away. Have the medicine packaging with you, even if it is empty, as this information will be useful.

What about using other medicines with amikacin?

Other inhaled antibiotics such as tobramycin (TOBI®) should not be given when your child is on inhaled amikacin.

Your child’s usual medicines for cystic fibrosis are to be continued including other inhaled medicines. Ask your pharmacist or cystic fibrosis nurse if the other inhaled medicines need to be given in a specific order or spaced out.

Check with your doctor or pharmacist about other medicines your child is using and before starting new products. This includes prescription and over the counter medicines, vitamins or supplements, herbal or complementary medicines that you buy from a pharmacy, supermarket, health food shop or online store.

You can give your child medicines that contain paracetamol or ibuprofen (anti-inflammatories) to treat pain and fever, unless your doctor has told you not to.

Possible side effects – what other effects can occur?

Side effects you must do something about

Take your child to hospital or call 000 for an ambulance if your child has:

• excessive wheezing, chest tightness, or coughing
• coughing up blood
• skin rash
• ringing in the ears (tinnitus), hearing loss
• dizziness, unsteadiness when standing or spinning feeling in the head (vertigo)

Other side effects you need to know about

Some side effects go away with time or after the dose is changed. Speak to your doctor if concerned about any of the following or if you notice other effects.

• cough
• chest tightness
• temporary voice change
• unusual taste in the mouth

General medicine advice

Never give this medicine to anyone else, even if their condition appears to be the same, as this could do harm. Contact Poisons Information Centre on 13 11 26 if another person uses it.

Store amikacin vials in a cool dry cupboard, away from heat, direct sunlight and moisture, below 25 ^oC. DBL brand amikacin should not be stored in the fridge.

Return expired amikacin, sodium chloride 0.9% ampoules or medicines you no longer need to your pharmacy.

Store all medicines out of sight and where children cannot reach. Always keep the medicine in the container it came in.

For more information

This fact sheet is about inhaled amikacin in children and young people. The information will be different from the manufacturer’s Consumer Medicine Information (CMI) which is about giving amikacin as an injection. The manufacturer’s CMI is found at NPS MedicineWise

• Talk to your doctor or pharmacist.
• Before you leave hospital, your Cystic Fibrosis nurse will talk about the specific nebuliser with filter attachment needed for amikacin such as e-Flow® Rapid, Aeroneb® Go nebuliser or Pari LC Sprint® nebulising bowl.

Contact us

In an emergency, always contact Triple Zero (000) for immediate assistance

Respiratory and Sleep Department
Level 5A, Queensland Children’s Hospital
501 Stanley Street, South Brisbane
t: (07) 3068 2303 (9am – 5pm weekdays)
e: QCH_CF@health.qld.gov.au

Pharmacy Department
Level 2, Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 1901 (9am – 5pm daily)

Endorsed by Queensland Children’s Hospital Medication Safety Committee and developed by pharmacy and respiratory and sleep departments with input from parents and carers.

Resource ID: CHQ-MFS-75703. Reviewed: 24 March 2021.

Contact CHQMedicationSafety@health.qld.gov.au for sources used to create this Fact Sheet.

Disclaimer: We take great care to make sure the information in this Fact Sheet is correct, up-to-date and reflects current use in Australia. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something.

This Fact Sheet is to be used as an aid, rather than a substitute for a discussion with your doctor or pharmacist. Children’s Health Queensland Hospital and Health Service accepts no responsibility for any inaccuracies, omissions, reliance placed, or the success of any treatment regimens detailed in this Fact Sheet.