• Assess for infection (vital signs, urine, WBC) at beginning of and during therapy.
• Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
• Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dysfunction is associated with persistently elevated peak plazomicin levels. Discontinue plazomicin if tinnitus or subjective hearing loss occurs.
• Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.
• Monitor intake and output and daily weight to assess hydration status and renal function.
• Assess for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea).
• Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritus, laryngeal edema, wheezing) during therapy.

Lab Test Considerations:

• Monitor CCr prior to starting and daily during therapy.

Toxicity and Overdose:

• Monitor blood levels periodically during therapy. Timing of blood levels is important in interpreting results. Draw trough levels within 30 min before infusion of 2nd dose. Extend dosing interval by 1.5 fold (i.e., from every 24 hr to every 36 hr or from every 48 hr to every 72 hr) for patients with plasma trough concentrations ≥3 mcg/mL.