2mg/kg IV load then 1.7mg/kg IV q8h
High Dose Extended Interval (HDEI)
5-7mg/kg IV q24h IV
Pseudomonal and other gram negative infections.
Inhaled form used in cystic fibrosis.
Consult pharmacist for level interpretation and dosing.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Target Trough <1 ug/mL
For Conventional Dosing
Trough 1-2 ug/mL; Target Peak 4-10 ug/mL
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.
Avoid concomitant nephrotoxins
Less common with HDEI
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: 3.0
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic