Infectious Disease Compendium

Gentamicin

Dosing

CrCl Formula

What follows is the old fashioned way to dose gentamicin, useful for endocarditis. For once a day dosing and rational click here.

CrCl > 80: 1-1.7 mg/kg q 8 h.

CrCl 80-50: 1-1.7 mg/kg q 8- 12 h.

CrCl 50-10: 1-1.7 mg/kg q 12 - 48 h.

CrCl < 10: 1-1.7 mg/kg q 48.

Hemodialysis: 1-1.7 mg/kg.

Peritoneal dialysis:

Want a peak of 2 - 4 ug/ml, a trough <2 ug/ml with the old way of dosing (the dosing when you use aminoglycosides for endocarditis synergy).

Important side effects

Nephro and oto toxicity; if you are not aware of this and you have MD after your name, time to pack it in and call it a day. Your time to practice medicine is over. For the record, Dr. Park did know this and many things besides. The oto toxicity may be decreased with 1 gm po tid aspirin (PubMed) and by N-­Acetylcysteine (PubMed) . Neuromuscular blockade and respiratory paralysis.

Important drug interactions

Nephro and oto toxicity increased with other nephrotoxic drugs. Bumetanide, capreomycin, carboplatin, cephalosporins, cidofovir, cyclosporine, ethacrynic acid, furosemide, indomethacin, lysine, magnesium, methoxyflurane, nondepolarizing neuromuscular blockers, piretanide, polygeline, succinylcholine, tacrolimus, typhoid vaccine, vancomycin.

Rants and Screeds

Pearls

Aminoglycosides of all kinds do not work in nor penetrate into pus, use in pus a waste of time. They are great in blood and urine, and have some utility in the clot of endocarditis. As a rule it should be used short term and for synergy.

By the way, aminolgycosides should probably be used as monotherapy only for urinary tract infections (PubMed).

Treatment of choice

Use for

Acinetobacter infections, Acne, Actinomyces, Aeromonas hydrophilia infections, Appendicitis, bacteremia, blepharitis, blepharoconjunctivitis, Brucella, burns, Calymmatobacterium granulomatis infections, Campylobacter infections, Cat scratch fever, Conjunctivitis, corneal ulcers, Corynebacterium jeikeium infections, Cystic fibrosis, dacryocystitis, Diarrhea, Diverticulosis/itis, ecthyma, eczematoid dermatitis, Endocarditis prophylaxis and treatment, Enterococcus, Folliculitis, Furuncles, Gonorrhea, gynecologic infections, hot tub rash, impetigo contagiosa, keratitis, keratoconjunctivitis, Klebsiella infections, Listeria monocytogenes, malignant Otitis externa, Meningitis, M. avium-intracellulari, necrotizing enterocolitis, neonatal sepsis, ocular infections, Osteomyelitis, PID, peripartum uterine infection, Plague, Pneumonia, pressure sores, Proteus infections, Providencia stuartii infections, Pseudomonas infections, psoriasis, Pyoderma gangrenosum, seborrheic dermatitis, Sepsis, Serratia marcescens infections, surgical prophylaxis, Tularemia, tympanostomy tube placement, UTI, wound irrigation, Yersinia enterocolitica infections.

Don't use for

The above represents the old fashioned way to give aminoglycosides, which maximize toxicity and minimize efficacy. For the new an improved way, with a the special additive HL450, click here. Or here.

Class

Aminoglycoside.