Restricted
Restricted Antimicrobial: See Approved Indications of Use.
Empiric (in combination) or targeted therapy for suspected or confirmed gram negative infections.
Empiric therapy for pyelonephritis.
Used synergistically for endocarditis.
Note: Autosub to tobramycin at OSMH unless clinically indicated for restricted use.
Pharmacist will consult, adjust dose and order serum drug levels and renal function monitoring.
Monitor Serum creatinine every Monday, Wednesday and Friday while on Gentamicin. Discontinue if any signs of ototoxicity.
Extended Interval Target Levels
Traditional Target Levels
Target Trough Level (mg/L) | Target Peak-Level (mg/L) |
---|---|
Serious Infections: < 1mg/L | UTI including pyelonephritis: 4-6 |
Life threatening infections: < 2mg/L | Sepsis, pneumonia, other serious infections: 6-8 |
Life-threatening infections: 8-10 |
Notes:
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
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.
With the exception of urinary tract infections, aminoglycosides are generally used in combination with other agents that have gram-negative activity, regardless of dosing method
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2 hours
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic