Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
For Multiple daily dosing: Target Peak 4-10 ug/mL, Trough 1-2 ug/mL.
For Once daily: Target Trough <1 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.
Nephrotoxicity (non-oliguric)
Avoid concomitant nephrotoxins
Less common with once daily dosing
Greater toxicity with longer duration and supratherapeutic trough levels
Vestibulocochlear toxicity
Irreversible
Require audiology testing if prolonged use
Can exacerbate neuromuscular blockade
Increased nephrotoxicity
Amphotericin B
Cyclosporine
Cisplatin
NSAIDS
Contrast dye
Vancomycin
Increased ototoxicity
Neuromuscular blockade agents - Respiratory paralysis.
Formal audiology assessment if planning to use aminoglycoside for >7d 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: 3 hours
Urine penetration: Therapeutic
Lung penetration: Therapeutic
CSF penetration: Poor
Biliary penetration: Moderate
