• Active tuberculosis (in combination with other agents).
• Serious enterococcal or gram-negative infections (in combination with other agents).

Contraindicated in:

• Hypersensitivity
• Cross-sensitivity among aminoglycosides may occur.

Use Cautiously in:

• Renal impairment (dosage adjustments necessary; plasma concentrations monitoring useful in preventing ototoxicity and nephrotoxicity)
• Hearing impairment
• Mitochondrial DNA variants in the 12S rRNA gene (MTRNR1) or maternal history of ototoxicity (↑ risk of ototoxicity)
• Neuromuscular diseases such as myasthenia gravis
• Obese patients (dosage should be based on ideal body weight)
• OB: May ↑ risk of congenital deafness when used during pregnancy
• Lactation: Safety not established in breastfeeding
• Geri: ↑risk of ototoxicity and nephrotoxicity in older adults.

EENT: ototoxicity (vestibular and cochlear).

F and E: hypomagnesemia.

GU: nephrotoxicity.

MS: muscle paralysis (high parenteral doses).
Misc: hypersensitivity reactions.

Drug-Drug:

• Inactivated by penicillins and cephalosporins when coadministered to patients with renal impairment.
• Possible respiratory paralysis after inhalationanesthetics or neuromuscular blockers.
• ↑risk of ototoxicity with loop diuretics.
• ↑risk of nephrotoxicity with other nephrotoxic drugs.

(Generic available)

• Lyophilized powder for injection: 1 g/vial;
• Solution for injection: 500 mg/mL;

• IM (Adults): Tuberculosis: 1 g/day initially, decreased to 1 g 2–3 times weekly;other infections: 250 mg–1 g every 6 hr or 500 mg–2 g every 12 hr.
• IM (Children): Tuberculosis: 20 mg/kg/day (not to exceed 1 g/day);other infections: 5–10 mg/kg every 6 hr or 10–20 mg/kg every 12 hr.

• Inhibits protein synthesis in bacteria at level of 30S ribosome.

• Bactericidal action.

Spectrum:

• Notable for activity against.
• Enterococci (synergy with a penicillin is required).
• Also active against Mycobacterium.

Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

Absorption: Well absorbed after IM administration. Negligible absorption when administered orally.

Distribution: Widely distributed throughout extracellular fluid. Poor penetration into CSF.

Metabolism/Excretion: Excretion is >90% renal.

Half-life: 2–4 hr (↑ in renal impairment).

(plasma concentrations†)

†All parenterally administered aminoglycosides.

• Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating.
  • Advise patient of the importance of drinking plenty of liquids.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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