Once daily dosing: 5-7mg/kg IV q24h
Multiple daily dosing: 1.5-2mg/kg IV q8h
N.B. use Dosing Weight (aka. Adjusted Body Weight) for obese patients
Enterococcal synergy: 1 mg/kg IV q8h
Empiric (in combination) or targeted therapy for suspected or confirmed gram negative infections.
Empiric therapy for pyelonephritis.
Used synergistically in enterococcal endocarditis.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: target trough <1mcg/mL
Multiple daily dosing: Peak monitoring poorly supported by literature, but target peak 4-10mcg/mL; trough 1-2mcg/mL only if using >4 days
NB: trough level is 0-60min before a dose (usually pre-4th), and peak is 30-60min 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.
Nephrotoxicity (non-oliguric)- less common with once daily dosing; greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins
Vestibulocochlear toxicity (irreversible)- require audiology testing if prolonged use
Can exacerbate neuromuscular blockade- e.g. contraindicated in patients with myasthenia gravis.
Amphotericin, vancomycin, cyclosporin, NSAIDs, increased contrast-induced nephrotoxicity
Loop diuretics (e.g. furosemide)- increased ototoxicity
Non-depolarizing muscle relaxants may be potentiated
Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop
Inform patient of risk of ototoxicity to report any symptoms
Contraindicated in patients with myasthenia gravis
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2.0
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic