General Information

Pseudomonal and other gram negative infections.

Inhaled form used in cystic fibrosis.

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
  •  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

  • Perform baseline and ongoing weekly otovestibular toxicity assessment. Formal audiology assessment required if symptoms develop.
  • Inform patient of risk of ototoxicity and to report any symptoms.

Calculation of Dosing Body Weight (DBW) DBW = IBW + [(ABW - IBW) x 0.4]

where: IBW male = 50kg + 0.906kg [Height (cm) - 152.4cm] IBW female = 45kg + 0.906kg [Height (cm) - 152.4cm]

Dosing Body Weight = DBW Ideal Body Weight = IBW Actual Body Weight = ABW