Low
NA
Empiric (in combination) or targeted therapy for suspected or confirmed gram negative infections.
Empiric therapy for pyelonephritis.
Used synergistically in enterococcal endocarditis.
Lab
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: Target trough <1mcg/mL
Multiple daily dosing: Peak monitoring poorly supported by literature, but target peak 4-10 mcg/mL; trough 1-2 mcg/mL (Only draw levels if using > 4 days)
In critically ill patients, check peak level after the 1st dose as volume of distribution and renal function may change rapidly.
Note: Trough level is 0-60 min before a dose (usually pre-4th), and peak is 30-60min after dose infused (usually post-3rd).
Clinical
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
Vancomycin
Cyclosporin
NSAIDs
Contrast
Increased ototoxicity
Non-depolarizing muscle relaxants may be potentiated
Formal audiology assessment if planning to use aminoglycoside for > 7 days 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: 2 hours
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic
