Gentamicin

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

High Dose Extended Interval 5-7mg/kg IV q24h

Multiple Daily Dosing 1.5-2mg/kg IV q8h

N.B. Use Dosing Weight (aka. Adjusted Body Weight) for obese patients

Dose per pharmacy

General Information

Used synergistically in enterococcal endocarditis. Empiric (in combination) or targeted therapy for suspected or confirmed gram negative infections.
Ob/gyn infections

Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.

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

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic

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