Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: Random level 6-14 hours post dose; plot level on nomogram
Multiple daily dosing (synergy and traditional): Obtain peak level 1 hour post-end of infusion and a trough level
Empiric (in combination) therapy for patients with history or risk of multi-drug resistant organisms and severe sepsis/septic shock
Dual-therapy: WIth few exceptions (e.g. endocarditis) Dual-therapy should be avoided. Adding an aminoglycoside to an active monotherapy agent results in no additional benefit and an increased incidence of nephrotoxicity.
Synergy: Reduces duration of therapy for streptococcal endocarditis Improves cure rates and mortality in enterococcal endocarditis
Nephrotoxicity (non-oliguric)
Vestibulocochlear toxicity
Can exacerbate neuromuscular blockade
Increased nephrotoxicity
Increased ototoxicity
Non-depolarizing muscle relaxants may be potentiated
Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop.
Inform patient of risk of ototoxicity and to report any symptoms.
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2 hours
Urine penetration: Therapeutic
Lung penetration: Therapeutic
CSF penetration: Poor
Biliary penetration: Moderate