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.