Monitor creatinine at least weekly and more often if levels are elevated or other signs of renal dysfunction arise. Discontinue if any signs of ototoxicity (tinnitus, fullness in ears, dizziness).
Serum Level Monitoring for EXTENDED Interval Dosing, Pediatrics: Obtain trough concentrations when treatment is anticipated to be longer than 48 hours. Measure trough level 1 hour prior to second dose. Target trough: less than 1 microgram/mL.If trough is less than 1 microgram/mL, continue current dose and repeat trough every 7 days.
Serum Level Monitoring for EXTENDED Interval Dosing, Neonates: Check gentamicin level at 22 hours post start of infusion, regardless of the dosing interval that the patient is started on for all patients with an anticipated gentamicin treatment greater than 48 hours. For patients less than or equal to 7 days of age in whom anticipated gentamicin treatment duration is less than or equal to 48 hours (i.e. clinical suspicion for early-onset sepsis is low), only order 22 hour gentamicin level if any or the following criteria apply:
Adjust dosing interval based on the 22-hour level drawn with the first dose by referring to the information below or in discussion with the pharmacist.
Serum Level Monitoring for EXTENDED Interval Dosing, Women's Health: For anticipated duration of therapy more than 2 days monitor serum gentamicin levels as follows: Measure level 18 hours after start of infusion (based on 30 minute infusion) to assess for adequate clearance. Target 18 hour level: 1 microgram/mL or less. If 18 hour level is within desired range, repeat every 4 days or sooner if clinically necessary.
Serum Level Monitoring for CONVENTIONAL Dosing, Pediatrics :
Serum concentrations of aminoglycosides should be monitored to ensure therapeutic levels have been achieved and to avoid potentially toxic levels. Obtain peak and trough concentrations when treatment is anticipated to be longer than 48 hours. Obtain drug levels with the third or fourth dose. Peak serum levels are drawn 30 minutes after the end of a 30 minute IV infusion or 1 hour following IM injection and should be 4-12 mcg/mL depending on infection. Trough levels are drawn just prior to the next dose (0-30 minutes) and should be less than 2 mcg/mL.
Serum Level Monitoring for SYNERGISTIC Dosing, Pediatrics : Targets are: Peak 3 to 5 mcg/mL and trough less than 2 mcg/mL.
Antimicrobial class: Aminoglycoside
Average serum half life:
Route of Elimination: Almost completely by glomerular filtration of unchanged drug with excretion into urine.