Antimicrobials
Gentamicin

Gentamicin

Low
N/A

Dosing

General Information

  • Empiric (in combination) or targeted therapy for suspected or confirmed Gram negative infections. Generally should not be used as monotherapy outside of UTIs
  • Empiric/targeted therapy for UTI or pyelonephritis. Single dose can be used for uncomplicated UTIs (especially multidrug resistant)
  • Used synergistically in streptococcal or enterococcal endocarditis
  • Renal function: frequent (daily) monitoring of SCr when therapy is started and throughout course of therapy (2-3x per week)
  • Hearing/vestibular toxicity (irreversible): complete audiology testing and vestibular toxicity monitoring after 3 days of therapy and regularly during prolonged therapy
  • Therapeutic level monitoring: consult pharmacy to ensure appropriate monitoring based on dosing type and infection

Nephrotoxicity (non-oliguric)

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

Vestibulocochlear toxicity

  • Irreversible
  • Audiology/vestibular testing indicated after 3 days of therapy and regularly for longer durations

Can exacerbate neuromuscular blockade

  • Contraindicated in patients with myasthenia gravis

Allergic reaction

  • Increased nephrotoxicity with other nephrotoxic agents (amphotericin, vancomycin, NSAIDs, contrast, loop diuretics)
  • Increased ototoxicity with loop diuretics, avoid co-administration
  • Non-depolarizing muscle relaxants may be potentiated resulting in possible respiratory depression
  • Penicillins: in vitro inactivation, do not mix or run in same tubing

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.

Distribution: distributes adequately into extracellular fluid, ascitic/peritoneal fluid, pericardial fluid, pleural fluid, synovial fluid, and lymphatic fluid. High urinary concentrations. Not well distributed into bile, aqueous humor, bronchial secretions, abscess, sputum, or CSF.