Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: Hartford nomogram.
Renal dysfunction and extended interval dosing: Peak monitoring poorly supported by literature, but target peak 8-10mcg/mL; trough 1-2mcg/mL
Trough is 30 minutes before next dose. Peak is 30 minutes after 30 minute infusion
In critically ill patients, check peak level after the 1st dose as volume of distribution and renal function may change rapidly.