C difficile risk
Oral Bioavailability


Multiple Daily Dose 2mg/kg IV load then 1.7mg/kg IV q8h

Once Daily 5-7mg/kg IV q24h IV

eGFR 0 - 10eGFR 10 - 20eGFR 20 - 30eGFR 30 - 40eGFR 40 - 60eGFR 60 - 80eGFR > 802mg/kg IV q72h3mg/kg IV q48h4mg/kg IV q48h2.5mg/kg IV q24h3.5mg/kg IV q24h4mg/kg IV q24h5-7mg/kg IV q24h

eGFR 0 - 10 eGFR 10 - 50 eGFR > 50 1.7mg/kg q48h1.7mg/kg IV q12-24h1.7mg/kg IV q8h

Multiple Daily Dosing 1.7mg/kg IV q48h, and 0.85mg/kg IV after dialysis sessions

3mg/kg IV load then 2mg/kg IV q24h

General Information

Pseudomonal and other gram negative infections.

Inhaled form used in cystic fibrosis.

Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.

For Multiple daily dosing: Target Peak 4-10 ug/mL, Trough 1-2 ug/mL.

For Once daily: Target Trough <1 ug/mL

NB: Trough level is 0-60min before a dose (usually pre-4th), and peak is 30-60min after dose infused (usually post-3rd).

In critically ill patients, check peak level after the 1st dose as volume of distribution and renal function may change rapidly.

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

  • Cyclosporine

  • Cisplatin


  • Contrast dye

  • Vancomycin

Increased ototoxicity

  • 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

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 3 hours

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic

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