Gentamicin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

Once daily dose: 5–7 mg/kg, dose is then adjusted according to levelsEndocarditis: 1 mg/kg every 8 hours Intrathecal: 1–5 mg daily PD peritonitis: see local policy

PHARMACOKINETICS

Molecular weight :477.6

%Protein binding :0–30

%Excreted unchanged in urine : 90

Volume of distribution (L/kg) :0.3

half-life – normal/ESRD (hrs) :2–3/20

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–70 3–5 mg/kg daily and monitor levels10–30 2–3 mg/kg daily and monitor levels5–10 2 mg/kg every 48–72 hours according to levels

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed.

CAPD : clearance is about 3 mL/min. Dose as in GFR=5–10 mL/min. Monitor levels

HD :Dialysed. Dose as in GFR=5–10 mL/min. Give after dialysis

HDF/high flux :Dialysed. Dose as in GFR=5–10 mL/min. Give after dialysis

CAV/VVHD :Dialysed. Dose in GFR= 30–70 mL/min according to severity of infection, and measure levels

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsBotulinum toxin: neuromuscular block enhanced – risk of toxicity

Ciclosporin: increased risk of nephrotoxicityCytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds

Diuretics: increased risk of ototoxicity with loop diureticsMuscle relaxants: effects of non- depolarising muscle relaxants and suxamethonium enhancedParasympathomimetics: antagonism of effect of neostigmine and pyridostigmine

Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

IV, IM, IP, intrathecal

Rate of Administration

Bolus IV: over not less than 3 minutes Short infusion: 20–30 minutes Once daily large infusions over 30– 60 minutes

Comments

Can be added to sodium chloride or glucose 5%

OTHER INFORMATION

Concurrent penicillins may result in sub- therapeutic blood levelsMonitor blood levels. 1 hour post-dose peak levels must not exceed 10 mg/L. Pre-dose trough levels should be less than 2 mg/LIP therapy commonly used for PD peritonitis. Dose varies according to local protocol and whether

CAPD : or APD dialysis. Monitoring of blood levels is advisable, as absorption is increased by inflamed peritoneumPotential nephrotoxicity of the drug may worsen residual renal functionLong-term concurrent use of gentamicin with teicoplanin causes additive ototoxicity.

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