Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Gentamicin/Tobramycin

Neonatal Dosing

  • 0-7 days old and

  • Less Than 34 Weeks PMA

3 mg/kg/dose IV q24h

  • 0-7 days old and

  • Greater/Equal 34 Weeks PMA

3 mg/kg/dose IV q18h

  • Greater Than 7 Days Old and

  • Less Than/Equal to 1 kg

3.5 mg/kg/dose IV q24h

  • Greater Than 7 Days Old and

  • Greater Than 1 kg and

  • Less Than 37 Weeks PMA

2.5 mg/kg/dose IV q12h

  • Greater Than 7 Days Old and

  • Greater Than 1 kg and

  • Greater/Equal 37 Weeks PMA

2.5 mg/kg/dose IV q8h

Levels

If intended course of gentamicin/tobramycin is greater than 72 hrs, levels need to be ordered as follows:

For Once-Daily Dosing

Order levels 3 and 6 hrs post-dose

Pharmacokinetic Targets
Extrapolated Cmax = 16-25 mg/L;
Drug-Free Interval (DFI) greater than 4 hrs

For Traditional Multiple Daily Dosing (i.e. q8h)

Target Levels for UTI
Trough 0.6-2 mg/L; Peak 3-5 mg/L

Target Levels for Pyelonephritis
Trough 0.6-2 mg/L; Peak 5-7 mg/L