Amikacin syndrome

In a randomized, prospective, cost-effectiveness study both teicoplanin and vancomycin were assessed as second-line therapy in 66 neutropenic patients after the failure of empirical treatment with a combination of piperacillin -I- tazobactam and amikacin (10). The primary success of second-line therapy was equivalent, and the direct total costs were similar. Acquisition costs per dose were in favor of vancomycin, but costs derived from administering vancomycin and serum concentration monitoring led to similar costs for both regimens. With the exception of the red man syndrome, which occurred in 10% of vancomycin-treated patients but none of the tei-coplanin-treated patients, toxicity (renal, liver, and ear toxicity, diarrhea, phlebitis) was also similar. 

Mineral balance Type 5 Bartter-like syndrome with severe hypocalcemia has been attributed to amikacin [7 ]. 

A 39-year-old man with suspected urinary tract infection received amikacin and after 4 days he developed severe renal tubular dysfunction resulting in refractory hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and polyuria. This constellation of biochemical abnormalities mimic Type 5 Bart-ter s syndrome (activating mutation of the calcium sensing receptor in the thick ascending loop of Henle and the distal tubule). Laboratory values returned to normal 15 days after discontinuation of amikacin... 

Chrispal A, Boorugu H, Prabhakar AT, Moses V. Amikacin-induced type 5 Bart-ter-like syndrome with severe hypocalcemia. J Postgrad Med 2009 55(3) 208-10. 

Bensaid B, Rozieres A, Nosbaum A, Nicolas JF, Berard F. Amikacin-induced drug reaction with eosinophilia and systemic symptoms syndrome delayed skin test and ELISPOT assay results allow the identification of the culprit drug. J Allergy Clin Immunol 2012 130(6) 1413. ... 

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