Once Daily Gentamicin Dosing

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Once Daily Gentamicin Dosing

Gentamicin is a highly effective antibiotic for treating many infections, especially those arising from the gastrointestinal and urinary tract or hospital acquired pneumonias. Recent studies have shown that gentamicin can be given as a single dose rather than in divided doses. This is easier for the ward staff, requires fewer levels to be taken, and appears to be less nephrotoxic. The effect on ototoxicity is still unclear. This regimen is ideal for short courses e.g. 5 days. Longer courses will need conventional dosing. It is not appropriate for some groups either because of lack of published data, or risk of accumulation and toxicity.

Not to be used in:

Children, (Neonates follow separate cross-town NNU guidelines)
Cystic fibrosis patients
Profound neutropenia
Pregnancy
Endocarditis

Dosage:

5mg / kg / dose (Reduce dose in renal failure) to a maximum 500mg.
Round the dose up or down to the nearest 40mg increment e.g. 320mg or 360mg
Give as an infusion over 20-30 minutes
Click here for advice on dosing in obese patients.

Monitoring of gentamicin levels:

Take a trough level 18-24 hours after the first dose, the ideal trough is less than 1.0mg/L
In a patient <65 years, if the serum creatinine is normal with good urine output give the second dose without waiting for the result
In a patient >65 years old or with abnormal renal function, await the result and advice from the medical microbiologist
It is not necessary to do a post dose level
Significantly abnormal results will be phoned by a medical microbiologist, and advice given as to further dosing
Try and time the dose so that it is convenient for the levels e.g. 10.00am

Monitoring of renal function:

Renal function should be checked at least three times a week and levels should be checked twice weekly during a treatment course.
If renal function deteriorates then renal function should be checked daily and gentamicin levels closely monitored. A dose reduction may be required.
All patients prescribed more than one dose of Gentamicin should have a fluid balance chart completed and urine output should be closely monitored.

Page last edited: 14/04/2009

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.