Spectrum Of Activity
Once Daily Dosing 5 mg/kg IV q24h
Multiple Daily Dosing 1-1.7 mg/kg IV q8h
Age <1w 2.5 mg/kg IV q12h
Age 1w-1y 2.5 mg/kg IV q8h
Age 1-12y 2-2.5 mg/kg IV q8h
No dose adjustment
CrCl >80CrCl 50-80CrCl 10-50CrCl <10HDCAPD1-1.7 mg/kg IV q8h1-1.7 mg/kg IV q8-12h1-1.7 mg/kg IV q12-48h1-1.7 mg/kg IV q48hAdditional 1-1.7 mg/kg ivIVafter HD0.5 mg/L of dialysate IV q24h
CrCl ≥80CrCl 60-70CrCl 50CrCl 30-40CrCl 20CrCl 10CrCl <105 mg/kg iv q24h4 mg/kg iv q24h3.5 mg/kg iv q24h2.5 mg/kg iv q24h4 mg/kg iv q48h3 mg/kg iv q48h2 mg/kg iv q48h
Empiric (in combination) or targeted therapy for suspected or confirmed gram negative infections.
Empiric therapy for pyelonephritis.
Used synergistically in enterococcal endocarditis.
Black Box Warning:
Patients with impaired renal function, advanced age, dehydration, and those who receive high doses or prolonged therapy are at an increased risk of toxicity.
Monitor renal and auditory function during therapy and discontinue therapy or adjust dose if there is evidence of ototoxicity or nephrotoxicity.
Serum concentrations of aminoglycosides should be monitored when feasible to assure adequate levels and to avoid potentially toxic levels.
Concurrent use of other potentially neurotoxic or nephrotoxic agents, or potent diuretics should be avoided.
Aminoglycosides can cause fetal harm when administered to a pregnant woman.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: Target trough <1 mcg/mL
Multiple daily dosing: Peak monitoring poorly supported by literature, but target peak 4-10 mcg/mL; trough 1-2 mcg/mL only if using >4 days
NB: Trough level is 0-60 min before a dose (usually pre-4th), and peak is 30-60 min 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.
Avoid concomitant nephrotoxins
Less common with once daily dosing
Greater toxicity with longer duration and supratherapeutic trough levels
Require audiology testing if prolonged use
Can exacerbate neuromuscular blockade
- Contraindicated in patients with myasthenia gravis
Loop diuretics (e.g. Furosemide)
Non-depolarizing muscle relaxants may be potentiated
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2 hours
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic
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.