Use Adjusted Body Weight for obese patients (BMI ≥30 kg/m2) Once Daily Dosing 5-7 mg/kg IV every 24 hr Multiple Daily Dosing 1.5-2 mg/kg IV every 8 hr Synergy(for gram positive infections) 1 mg/kg IV every 8 hr Recommend dosing per Pharmacy
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 4-10 mcg/mL; trough 1-2 mcg/mL (Only draw levels if using > 4 days)
In critically ill patients, check peak level after the 1st dose as volume of distribution and renal function may change rapidly.
Note: Trough level is 0-60 min before a dose (usually pre-4th), and peak is 30-60min after dose infused (usually post-3rd).
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
Non-depolarizing muscle relaxants may be potentiated
Formal audiology assessment if planning to use aminoglycoside for > 7 days or if symptoms develop.
Inform patient of risk of ototoxicity and to report any symptoms.
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2 hours
CSF penetration: Poor
Biliary penetration: Moderate
Lung penetration: Therapeutic
Urine penetration: Therapeutic