Aminoglycoside

Aka: Aminoglycoside, Gentamicin, Garamycin

1. Pharmacokinetics
   1. Maintain Trough <2 ug/ml
      1. Drawn immediately before next dose
   2. Maintain Peak at 5-8 ug/ml (4-6 ug/ml for child)
      1. Draw 1 hour after Intramuscular dose
   3. Indications for pharmacokinetics followed by PharmD
      1. Aminoglycoside use over 3 days
      2. Renal dysfunction
2. Precautions
   1. Administer IV dose over 1 hour
   2. Adjust dosing per kinetics if >1-2 days use
   3. Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
3. Dosing: Infants
   1. Term Infant
      1. Gentamycin 2.5 mg/kg/dose IV or IM q8 hours
   2. Preterm Infant
      1. Gestational Age >34 weeks and Weight over 2000 grams
         1. Gentamycin 2.5 mg/kg/dose IV or IM q12 hours
      2. Gestational Age <34 weeks
         1. Weight over 1250 grams
            1. Gentamycin 2.5 mg/kg/dose IV or IM q18 hours
         2. Weight Under 1250 grams
            1. Gentamycin 2.5 mg/kg/dose IV or IM q24 hours
      3. Age >7 days
         1. Gentamycin 2.5 mg/kg/dose IV or IM q12 hours
   3. Renal Impairment Adjustments
      1. Serum Creatinine 0.7 to 1.1
         1. Gentamycin 2.5 mg/kg/dose IV or IM q24 hours
      2. Serum Creatinine 1.1 to 1.3
         1. Gentamycin 2.5 mg/kg/dose IV or IM q36 hours
      3. Serum Creatinine > 1.3
         1. Gentamycin 2.5 mg/kg/dose IV or IM q48 hours
4. Dosing: Children and adults
   1. Child
      1. Gentamicin 2 to 2.5 mg/kg IV or IM q8 hours
      2. Gentamicin 4.5 mg/kg IV q24 hours
   2. Adults
      1. Gentamicin 1-1.5 mg/kg IV or IM q8 hours or
      2. Gentamicin 5-7 mg/kg IV q24 hours
5. Risk Factors for Nephrotoxicity
   1. Advanced age
   2. Prior renal insufficiency
   3. Dehydration
   4. Hypokalemia
   5. Hypomagnesemia
   6. Liver disease
   7. Sepsis
   8. Drug interactions with other nephrotoxic medications
      1. Cephalothin (Keflin) and other Cephalosporins
      2. Cyclosporin A
      3. Cisplatin
      4. NSAIDS
      5. ACE Inhibitors
      6. Methoxyflurane
      7. Loop Diuretics
      8. Amino acids