3mg/kg (S. viridans endocarditis)
Note, the choice of the dosing interval is based on the patient's renal function.
The patient's urinary output should be considered in addition to the serum creatinine concentration.
CrCl Greater Than 70 mL/min: Q8h
CrCl 40-69 mL/min: Q12h
CrCl 20-39 mL/min: Q24h
CrCl Less Than 20 mL/min: Give a dose and draw levels in 24 hours to determine dosing interval.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Target trough: less than 1mg/L
Target peak: 3-4mg/L
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 once daily dosing
Greater toxicity with longer duration and supratherapeutic trough levels
Require audiology testing if prolonged use
Can exacerbate neuromuscular blockade
Non-depolarizing muscle relaxants may be potentiated
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 2 hours
Biliary penetration: Moderate
CSF penetration: Poor
Used synergistically in enterococcal endocarditis