Can't find Amikacin? Learn about alternative aminoglycoside antibiotics and other options your doctor may consider for serious bacterial infections.
Being told your antibiotic is out of stock is scary — especially when you're dealing with a serious infection. Amikacin is a powerful medication that doctors don't prescribe lightly, so hearing that it's unavailable can feel like a dead end.
But it's not. While Amikacin is uniquely effective for certain resistant infections, there are real alternatives your doctor can consider. In this guide, we'll explain what Amikacin does, how it works, and which medications may be able to take its place when supply runs short.
Important: Never switch antibiotics on your own. Any change must be guided by your doctor based on your specific infection, lab results, and medical history.
Amikacin is an aminoglycoside antibiotic — a class of drugs that kill bacteria by stopping them from making essential proteins. It's given by injection (into a vein or muscle) and is used to treat serious infections including:
Doctors often turn to Amikacin when bacteria are resistant to other aminoglycosides like Gentamicin or Tobramycin. For a complete overview, see our guide on what Amikacin is and how it's used.
Amikacin works by binding irreversibly to the 30S ribosomal subunit of bacteria. This is the part of the bacterial cell that reads genetic instructions to build proteins. When Amikacin attaches to it, the bacteria can no longer produce the proteins they need to grow and survive, and they die.
What makes Amikacin special among aminoglycosides is its resistance to many of the enzymes that bacteria use to break down other drugs in this class. That's why it often works when Gentamicin or Tobramycin don't. Learn more about this in our article on how Amikacin works.
If Amikacin is unavailable, your doctor will consider alternatives based on the type of infection, the bacteria causing it (identified through cultures and sensitivity testing), and your overall health. Here are the most common options:
Gentamicin is the most widely used aminoglycoside antibiotic and is generally easier to find and less expensive than Amikacin. It works through the same mechanism — blocking bacterial protein synthesis — and is effective against many of the same gram-negative organisms.
When it may work: If your bacteria are sensitive to Gentamicin on culture testing, it's often the first-line alternative. It's widely available as a generic injectable.
Limitations: Some bacteria that are resistant to Gentamicin may still be sensitive to Amikacin. Gentamicin also carries similar risks of kidney damage and hearing loss, and dosing requires careful monitoring.
Tobramycin is another aminoglycoside that's particularly effective against Pseudomonas aeruginosa — a common cause of hospital-acquired infections and a major concern for patients with cystic fibrosis. It's available as an injectable and as an inhaled formulation (TOBI).
When it may work: For Pseudomonas infections or when inhaled aminoglycoside therapy is needed, Tobramycin is often preferred. It's generally more available than Amikacin.
Limitations: Like Gentamicin, bacteria resistant to Tobramycin may still be sensitive to Amikacin. Tobramycin has the same nephrotoxicity and ototoxicity risks as other aminoglycosides.
Plazomicin is a newer aminoglycoside approved by the FDA in 2018 for complicated urinary tract infections (cUTI) and pyelonephritis. It was specifically designed to resist the enzymes that bacteria use to inactivate older aminoglycosides.
When it may work: Plazomicin may be effective against bacteria that are resistant to Amikacin, Gentamicin, and Tobramycin. It's a strong option for multidrug-resistant gram-negative infections.
Limitations: Plazomicin is significantly more expensive than generic aminoglycosides and has a narrower FDA-approved indication. Availability may also be limited, and insurance coverage can require prior authorization.
Streptomycin is one of the oldest aminoglycosides, primarily used today for tuberculosis (TB) treatment regimens and certain cases of bacterial endocarditis. It's given by intramuscular injection.
When it may work: If Amikacin was being used as part of an MDR-TB treatment regimen, Streptomycin may be an alternative depending on resistance patterns.
Limitations: Streptomycin has a narrower spectrum of activity than Amikacin and is not interchangeable for most gram-negative infections. It's also subject to its own shortage issues.
In some cases, your doctor may look outside the aminoglycoside class entirely. Options may include:
The right alternative depends entirely on your specific situation. Your infectious disease doctor will use your culture and sensitivity results to make the best choice.
Not being able to find Amikacin is stressful, but it doesn't mean you're out of options. Work closely with your doctor — ideally an infectious disease specialist — to identify the best alternative for your infection. Tools like Medfinder can help you check whether Amikacin or its alternatives are in stock near you.
For more information, read our guides on why Amikacin is so hard to find, how to find Amikacin in stock, and Amikacin drug interactions.
You focus on staying healthy. We'll handle the rest.
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