Multiple Daily Dose (MDD) 2mg/kg IV load then 1.7mg/kg IV q8h
Once Daily (OD) 5-7mg/kg IV q24h IV
0 - 20 eGFR20 - 39 eGFR40 - 59 eGFR60+ eGFR2mg/kg load then dose as per levels1.7mg/kg q24h1.7mg/kg IV q12h1.7mg/kg q8h
0 - 40 eGFR40 - 59 eGFR60+ eGFRAVOID use. If necessary, use conventional aminoglycoside dosing5-7mg/kg q36h5-7mg/kg q24h
2mg/kg load post HD, then 1.5mg/kg post HD
3mg/kg IV load then 2mg/kg IV q24h
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
For MDD: Target Peak 4-10 ug/mL, Trough 1-2 ug/mL.
For OD: Target Trough <1 ug/mL
NB: trough level is 0-60min before a dose (usually pre-4th), and peak is 30-60min after dose infused (usually post-3rd).
In critically ill patients, check peak level after the 1st dose as volume of distribution and renal function may change rapidly.
Nephrotoxicity (non-oliguric)- less common with once daily dosing; greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins
Vestibulocochlear toxicity (irreversible)- require audiology testing if prolonged use
Can exacerbate neuromuscular blockade- e.g. contraindicated in patients with myasthenia gravis.
Increased nephrotoxicity with: amphotericin B, cyclosporine, cisplatin, NSAIDS, contrast dye, vancomycin.
Increased ototoxicity: furosemide.
Neuromuscular blockade agents- respiratory paralysis.
Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop
Inform patient of risk of ototoxicity to report any symptoms
Contraindicated in patients with myasthenia gravis
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 3.0
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic
