Once Daily/Extended Interval Dosing
7mg/kg dosing body weight (DBW) IV q24h
Multiple Daily Dosing
1.5-2mg/kg dosing body weight (DBW) loading dose then 1.5 mg/kg DBW IV q8h
DBW = Dosing body weight. See Additional information
Pseudomonal and other gram negative infections.
Inhaled form used in cystic fibrosis.
Monitor serum creatinine, BUN 2-3 times/week. Discontinue if any signs of ototoxicity.
For once daily/extended interval dosing dosing:
Peak levels are not recommended
NO level is required in patients with good renal function and therapy anticipated to be less than 8 days
Patient populations to consider a serum concentration independent of duration of therapy:
A single serum concentration can be drawn between 6 to 14 hours after the start of the aminoglycoside infusion (typically a 8-10 hour post concentration is drawn.)
For conventional multiple times per day dosing:
Target Peak 3-10 mg/L, Trough <2 mg/L. Peak levels usually not required but if drawn, record time of dose and time of level draw as accurately as possible.
Contact pharmacy for monitoring set up, level interpretation and dose individualization
NB: Trough level is 30-60min BEFORE next dose dose, and peak is 30-60min AFTER dose infused.
For Intermittent OR Continuous dialysis:
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
Neuromuscular blockade agents - Respiratory paralysis.
Perform baseline and ongoing weekly otovestibular toxicity assessment. Formal audiology assessment required if symptoms develop.
Inform patient of risk of ototoxicity and to report any symptoms.
Calculation of Dosing Body Weight (DBW)
DBW = IBW + [(ABW - IBW) x 0.4]
IBW male = 50kg + 0.906kg [Height (cm) - 152.4cm]
IBW female = 45kg + 0.906kg [Height (cm) - 152.4cm]
Dosing Body Weight = DBW
Ideal Body Weight = IBW
Actual Body Weight = ABW
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 3 hours
Biliary penetration: Moderate
Lung penetration: Therapeutic
Urine penetration: Therapeutic
CSF penetration: Poor