CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

IM/IV: 3 mg/kg/day in 3 divided doses; maximum 5 mg/kg/day in 3–4 divided doses Urinary tract infections: 2–3 mg/kg daily as a single dose (IM)

PHARMACOKINETICS

  • Molecular weight                           : 467.5
  • %Protein binding                           : <5
  • %Excreted unchanged in urine     : 90
  • Volume of distribution (L/kg)       : 0.25
  • half-life – normal/ESRD (hrs)      : 2–3/5–70

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Give 1–2 mg/kg then dose according to serum levels
  • 10 to 20     : Give 1 mg/kg then dose according to serum levels
  • <10           : Give 1 mg/kg then dose according to serum levels

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                : Dialysed. Dose as in GFR <10 mL/min
  • HD                     : Dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux   : Dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD      : Dialysed. 1.5–2 mg/kg every 24 hours and monitor levels1

    IMPORTANT DRUG INTERACTIONS

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

  • Ciclosporin: increased risk of nephrotoxicity Cytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds
  • Diuretics: increased risk of ototoxicity with loop diuretics Muscle relaxants: enhanced effect of non-depolarising muscle relaxants and suxamethonium Parasympathomimetics: antagonism of effect of neostigmine and pyridostigmine
  • Tacrolimus: increased risk of nephrotoxicity

    ADMINISTRATION

    Reconstition

    Add to 50–100 mL sodium chloride 0.9% or glucose 5% for

    IV infusion

    Route

    IV, IM, IP, nebulised

    Rate of Administration

    20–60 minutes

    Comments

    Plasma concentrations should be measured frequently; trough ≤2 mg/L, peak 60 minutes post dose ≤10 mg/L; avoid prolonged peaks above 12 mg/L

    OTHER INFORMATION

    25–70% can be removed by haemodialysis Used via nebuliser for chronic pulmonary Pseudomonas aeruginosa infection in cystic fibrosis: 300 mg every 12 hours for 28 days, repeat after 28 days Can be used for peritonitis at doses of 6 mg/L intraperitoneally

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