Gentamicin
Dosing
Use actual body weight. If patient is obese use dosing body weight (see additional information)Multiple daily dosing: 2 mg/kg IV loading dose then 1.8 mg/kg IV q8h
Once daily dosing: 5 mg/kg IV daily
If patient has impaired renal function or is obese, consult pharmacy
Refer to BCWH Parenteral Drug Manual
IV, IM
10 mg/mL
For BCWH Golden Hour ONLY, first dose when administered OUTSIDE the NICUSupplied by Pharmacy1. Gentamicin retrieved from NICU Omnicell 2. No dilution required (*For priming, add 2 mL to calculated volume required) 3. Calculate volume required from gentamicin 10mg/mL vial: Volume required (mL) = Dose required (mg) ÷ 10mg/mL 4. Withdraw gentamicin from vial and infuse via syringe pump
24H Room Temp
General Information
Chorioamnionitis
Endometritis
Empiric therapy (in combination) or targeted therapy for suspected or confirmed gram negative infections
Empiric therapy for pyelonephritis
Used synergistically in enterococcal endocarditis
Pregnancy: Gentamicin crosses the placenta. No reports linking the use of gentamicin to congenital defects have been located. Ototoxicity, which is known to occur after gentamicin therapy in humans, has not been reported as an effect of in utero exposure. However, other aminoglycosides (streptomycin) have been associated with infant ototoxicity following in utero exposure. If gentamicin is required to treat a serious maternal infection, benefit likely outweighs potential risk.
Breastfeeding: Only very small amounts of gentamicin are found in breast milk and gentamicin is poorly orally absorbed. Likely compatible. Monitor infant for gastrointestinal side effects.
Consult pharmacy for all patients receiving gentamicin for therapeutic drug monitoring and dose individualization. Monitor creatinine at least 2 - 3 times/week. Formal audiology testing is recommended if therapy is planned to last greater than 2 weeks or symptoms occur. Discontinue if any signs of ototoxicity.
Multiple daily dosing: Serum levels recommended around the third dose following initial therapy or with any change in dose:
Pre-dose level: 0 to 30 minutes before next dose (should be less than 2 mg/L)
Post-dose level: 30 minutes after completion of an IV infusion (should be 6 - 10 mg/L, target can be lower for urinary tract infections and for synergy)
Once daily dosing: target trough: < 1 mg/L (peak levels not required)
Check gentamicin levels earlier in patients with impaired renal function
Nephrotoxicity (non-oliguric) - greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins
Vestibulocochlear toxicity (irreversible) - requires audiology testing if prolonged use
Can exacerbate neuromuscular blockade - e.g. contraindicated in patients with myasthenia gravis
Avoid use with other nephrotoxic agents (ie. vancomycin, NSAIDs, contrast).
Loop diuretics (e.g. furosemide) - increased ototoxicity.
Non-depolarizing muscle relaxants may be potentiated.
In obesity (total body weight (TBW) more than 125% ideal body weight (IBW)), dosing weight is IBW + 0.4 (TBW - IBW). Consult pharmacy.
Formal audiology assessment if planning to use aminoglycoside for greater than 2 weeks or if symptoms develop.
Inform patient of risk of ototoxicity to report any symptoms.
Contraindicated in patients with myasthenia gravis.
