Adult Dosing
Bacterial infections
- 8 mg/kg/day IM/IV divided q8 hrs; can be increased to 10 mg/kg/day in life threatening infections
- Alt: 5-7 mg/kg IV q24 hrs [Not FDA approved]
- Note: Many dosing regimens are used; most involve dosing adjusted on the basis of blood level monitoring and assessment of renal function. Usual duration of treatment is 7-10 days. Monitor peak/trough levels, desirable peak serum concentrations are 4-12 mcg/mL and trough concentrations should not exceed 1-2 mcg/mL
Bacterial endocarditis
- 3 mg/kg/day IM/IV in 3 equally divided doses concurrently with IV ampicillin/penicillin
- Note: Many dosing regimens are used; most involve dosing adjusted on the basis of blood level monitoring and assessment of renal function. Usual duration of treatment is 7-10 days. Monitor peak/trough levels, desirable peak serum concentrations are 4-12 mcg/mL and trough concentrations should not exceed 1-2 mcg/mL
Bronchiectasis [Not FDA Approved]
- 5-8 mg/kg IV administered daily, with monitoring of levels
Pharyngitis (Acute) [Non-FDA Approved]
- 5-8 mg/kg IV administered daily, with monitoring of levels
Pediatric Dosing
Bacterial infections
- Neonates
1 wk: 5 mg/kg/day IM/IV divided q12 hrs - Infants: 7.5 mg/kg/day IM/IV divided q8 hrs
- Child: 6-7.5 mg/kg/day IM/IV divided q8 hrs
- Note: Many dosing regimens are used; most involve dosing adjusted on the basis of blood level monitoring and assessment of renal function. Usual duration of treatment is 7-10 days. Monitor peak/trough levels, desirable peak serum concentrations are 4-12 mcg/mL and trough concentrations should not exceed 1-2 mcg/mL
Pediatrics Pneumonia [Non-FDA Approved]
- Neonates 1 wk: 5 mg/kg/day IM/IV divided q12 hrs
- Infants: 7.5 mg/kg/day IM/IV divided q8 hrs
- Child: 6–7.5 mg/kg/day IM/IV divided q8 hrs
[Outline]
- Gentamicin causes nephrotoxicity and neurotoxicity, risk factors include concomitant neurotoxic and/or nephrotoxic agents, diuretics, advancing age, and dehydration
- Obtain culture and susceptibility tests before starting therapy; use only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
- IV route is preferred for patients with bacterial septicemia, shock, congestive heart failure, hematologic disorders, severe burns, or those with reduced muscle mass
- Use with caution in patients with neuromuscular disorders (myasthenia gravis/parkinsonism), due to potential curare-like effects on the neuromuscular junction
- Dosage is calculated based on patient-specific pharmacokinetic parameters. Desirable peak serum concentrations: 4-12 mcg/mL; trough concentrations: 1-2 mcg/mL
- Aminoglycosides can cause fetal harm when administered to a pregnant woman
- Superinfection may occur, initiate appropriate therapy
- Cross-sensitivity among aminoglycosides may occur
- Higher doses are recommended in patients with cystic fibrosis, neutropenia, or burns
- Monitor BUN/Cr at baseline, then periodically; serum drug levels; urinalysis
- Perform audiometry for high risk pts, planned prolonged therapy, if high serum levels or signs of hearing impairment
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Auditory impairment
- Impaired vestibular function
- High dose therapy
- Prolonged treatment
- Electrolytes abnormalities
- Concurrent ototoxic agents
- Concurrent nephrotoxic agents
- Concurrent neurotoxic agents
- Neuromuscular disease
- Electrolyte abnormalities
- Dehydration
- Neonates/infants
- Geriatric population
Pregnancy Category:D
Breastfeeding: Gentamicin is poorly excreted in breastmilk. Monitor the infant for possible effects on the GI flora, such as diarrhea, candidiasis or rarely, blood in the stool indicating possible antibiotic-associated colitis. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 28 August 2010).
