Antimicrobials
Gentamicin

Gentamicin

Low
N/A
IV: $ + monitoring

Dosing

General Information

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)

  •  Avoid concomitant nephrotoxins
  •  Less common with once daily dosing
  •  Greater toxicity with longer duration and supratherapeutic trough levels

Vestibulocochlear toxicity

  • Irreversible
  • Require audiology testing if prolonged use

Can exacerbate neuromuscular blockade

  •  Contraindicated in patients with myasthenia gravis

Increased nephrotoxicity

  •  Amphotericin
  •  Vancomycin
  •  Cyclosporin
  •  NSAIDs
  •  Contrast

Increased ototoxicity

  •  Loop diuretics (e.g. furosemide)

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