High Dose Extended Interval (HDEI)
5-7mg/kg IV q24h
1.5-2mg/kg IV q8h
1 mg/kg IV q8h
N.B. use Dosing Weight (aka. Adjusted Body Weight) for obese patients
Targeted therapy for suspected or confirmed multidrug resistant gram negative infections.
Used synergistically in enterococcal endocarditis.
Consult clinical pharmacy for level interpretation and dosing.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Target trough <1mcg/mL
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, consider checking peak level after the 1st dose as volume of distribution and renal function may change rapidly.
Avoid concomitant nephrotoxins
Less common with HDEI dosing
Greater toxicity with longer duration and supratherapeutic trough levels
Require audiology testing if prolonged use
Can exacerbate neuromuscular blockade
Increased risk of respiratory paralysis
Formal audiology assessment at baseline if planning to use aminoglycoside for >7d or if symptoms develop.
Inform patient of risk of ototoxicity and to report any symptoms (oscillopsia, imbalance, hearing loss, tinnitus).
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2.0
Urine penetration: Therapeutic
CSF penetration: Poor
Biliary penetration: Moderate
Lung penetration: Therapeutic