Empiric (in combination) or targeted therapy for suspected or confirmed gram negative infections.
Empiric therapy for pyelonephritis.
Used synergistically in enterococcal endocarditis.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: Target trough <1mcg/mL
Multiple daily dosing: Peak monitoring poorly supported by literature, but target peak 4-10mcg/mL; trough 1-2mcg/mL only if using >4 days
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)
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