Monitor creatinine at least q 3 days. Discontinue if any signs of ototoxicity.

For once daily dosing:

• Target Trough < 0.5 ug/mL
• Target peak 5 mg/kg: 13-16 ug/mL
• Target peak 7mg/kg: 17-23 ug/mL

For multiple daily dosing:

• Target Peak Disease Specific Target trough < 1 ug/mL
• UTI: 4-6 ug/mL
• Soft tissue, pyelonephritis, sepsis: 6-8 ug/mL
• Pneumonia: 8-10 ug/mL

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 B
• Cisplatin
• Contrast Dye
• Cyclosporine
• NSAIDs
• Vancomycin

Increased ototoxicity

• Loop diuretics (e.g. furosemide)

Neuromuscular blockade agents - Respiratory paralysis

• 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
• Medication cost calculated per day (24 hours) of therapy for the average adult dose (70kg) of 350mg IV q24h