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Guidelines
Aminoglycoside Monitoring

Aminoglycoside Monitoring

Once daily dosing

  • 3 and 6 hours after dose
  • ±30 min at 3 hours and 6 hours after dose

Extrapolated maximum concentration (Cmax) of 16-25 mg/L, Drug-Free Interval (DFI) >4 hrs

If empiric course of aminoglycoside is expected to be less than or equal to 72 hours, NO serum levels need to be ordered

If the intended course of aminoglycoside is greater than 72 hours, “special” levels at 3hr and 6hr post-dose should be ordered for FIRST dose of each new course of ODD aminoglycoside

Q8H dosing or Dosing for renal impairment

  • 0-30 min before dose;
  • Target = 0.6-2 mg/L
  • 30-60 min after end of infusion;
  • Target = 5-10 mg/L

General Monitoring Parameters

Urinalysis, urine output, BUN, serum creatinine, peak and trough serum concentrations, hearing test especially for those at risk for ototoxicity or who will be receiving prolonged therapy (>2 weeks), CBC with differential

With conventional dosing, typically obtain serum concentration after the third dose; exceptions for earlier monitoring may include neonates or patients with rapidly changing renal function

With extended-interval dosing, usually obtain serum concentration after first, second, or third dose

Not all infants and children who receive aminoglycosides require monitoring of serum aminoglycoside concentrations

Indications for use of aminoglycoside serum concentration monitoring include:

  • Treatment course >5 days
  • Patients with decreased or changing renal function
  • Patients with poor therapeutic response
  • Neonates and Infants <3 months of age
  • Atypical body constituency (obesity, expanded extracellular fluid volume)
  • Clinical need for higher doses or shorter intervals (eg, cystic fibrosis, burns, endocarditis, meningitis, critically ill patients, relatively resistant organism)
  • Patients on hemodialysis or chronic ambulatory peritoneal dialysis
  • Signs of nephrotoxicity or ototoxicity
  • Concomitant use of other nephrotoxic agents