General Information

  • Enterobacterales and other gram-negative infections
  • Used synergistically in gram-positive endocarditis

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

Antimicrobial class: Aminoglycoside

Pregnancy category: D (short courses during pregnancy have been demonstrated as safe)

Average serum half life: 2 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate