Loading dose: 400 mg every 12 hours for 3 doses, thenIM/IV: 200–400 mg daily, or 3–6 mg/kg/day (up to 10 mg/kg/day in some reports) in life threatening infections
20 to 50     : Give normal loading dose, then dose as in normal renal function
10 to 20     : Give normal loading dose, then 200–400 mg every 24–48 hours
<10           : Give normal loading dose, then 200–400 mg every 48–72 hours
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Not dialysed. Dose as in GFR <10 mL/min
HD                     :Not dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Dialysed.1 Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
None known
ADMINISTRATION
Reconstition
Use water for injection provided
Route
IV, IM
Rate of Administration
IV bolus: 2–3 minutes;
IV infusion
: 30 minutes
Comments
USE IN
CAPD                : Give 400 mg IV stat dose, then 20 mg/L/ bag IP for 7 days, then 20 mg/L/alternate-bag for 7 days, then 20 mg/L/night-bag only for 7 days
OTHER INFORMATION
TDM optimises therapy, but not essential. Troughs not less than 10 mg/L. Peaks 1 hour after:
20 to 50     : mg/LRelationship between blood level and toxicity not establishedLong-term concurrent use of gentamicin and teicoplanin causes additive ototoxicity