Monitor serum creatinine, BUN 2-3 times/week. Discontinue if any signs of ototoxicity.

For once daily/extended interval dosing dosing:

• Peak levels are not recommended
• NO level is required in patients with good renal function and therapy anticipated to be less than 8 days
• Patient populations to consider a serum concentration independent of duration of therapy:
  • critically ill patients
  • rapidly changing renal status
  • increased or rapidly changing Vd (e.g. ascities, burn)
  • serum Cr unreliable indicator of renal function
  • concurrent nephrotoxic therapy (amphotericin B, vancomycin, chemotherapy, high furosemide, cyclosporine or tacrolimus etc.)

A single serum concentration can be drawn between 6 to 14 hours after the start of the aminoglycoside infusion (typically a 8-10 hour post concentration is drawn.)

• Contact pharmacy for monitoring set up, level interpretation and dose individualization.

For conventional multiple times per day dosing:

• Target Peak 3-10 mg/L, Trough <2 mg/L. Peak levels usually not required but if drawn, record time of dose and time of level draw as accurately as possible.
• Contact pharmacy for monitoring set up, level interpretation and dose individualization

NB: Trough level is 30-60min BEFORE next dose dose, and peak is 30-60min AFTER dose infused.

For Intermittent OR Continuous dialysis:

• Contact pharmacy for monitoring set up, level interpretation and dose individualization

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
•  NSAIDS
•  Contrast dye
•  Vancomycin

Increased ototoxicity

•  Furosemide

Neuromuscular blockade agents - Respiratory paralysis.

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 3 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate