Low
None
$3 + monitoring
Empiric (in combination) or targeted therapy for suspected or confirmed resistant gram negative infections.
Empiric therapy for pyelonephritis.
Used synergistically in enterococcal or streptococcal endocarditis.
Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.
Once daily dosing: Hartford nomogram.
Renal dysfunction and extended interval dosing: Peak monitoring poorly supported by literature, but target peak 8-10mcg/mL; trough 1-2mcg/mL
Trough is 30 minutes before next dose. Peak is 30 minutes after 30 minute infusion
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
Vancomycin
Cyclosporin
NSAIDs
Contrast
Increased ototoxicity
Non-depolarizing muscle relaxants may be potentiated
Restricted to Infectious Diseases, OBGYN (FBC) and NICU
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: 2 hours
Biliary penetration: Moderate
CSF penetration: Poor
Lung penetration: Therapeutic
Urine penetration: Therapeutic
