1.5-2mg/kg IV q8h
Extended Interval Dosing
5-7mg/kg IV q24h
Use Adjusted Body Weight for obese patients.
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 2 times/week. Discontinue if any signs of nephro or ototoxicity.
Extended Interval Dosing: Target trough <1mcg/mL
Traditional Dosing: Peak monitoring poorly supported by literature, but target peak 8-10mcg/mL; trough < 1 mcg/mL only if using >4 days
Note: 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.
Baseline and periodic hearing and vestibular function (questioning audiologic testing with prolonged therapy)
Amphotericin, vancomycin, cyclosporin, NSAIDs, contrast- increased 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
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2 hours
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic