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
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.