Renal dosing of Gentamicin

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Gentamicin: Dose adjustment for renal impairment

Cockcroft-Gault CrCl estimates (using the creatinine clearance calculator) should be used for drug dosing rather than the automated MDRD eGFR produced by the clinical chemistry laboratory available on NOTIS.

Many elderly patients have a Crcl below 50ml/min, which, because of reduced muscle mass, may not be indicated by a raised creatinine level. It is therefore. especially prudent to calculate the Crcl as outlined below for this patient group.

Anuric and oliguric (<500ml/day) patients can be assumed to have a CrCl < 10ml/min (severe renal impairment)

For dosing advice in haematology patients click here

Once daily Gentamicin

NB if patient is obese - dose correction must be made - click here

Crcl (ml/min)	Dose
10-40	3mg/kg (Maximum 300mg) Check levels 18-24 hours after first dose. Await the result and re-dose only when levels <1mg/L.
<10	2mg/kg (Maximum 200mg) Re-dose according to levels.

Traditional (Conventional) Gentamicin Dosing

Crcl (ml/min)	Dose
20 – 50	80mg every 12 hours (60mg if <60kg)
10 – 20	80mg every 24 hours (60mg if <60kg)
<10	80mg every 48 hours (60mg if <60kg)

Close monitoring of serum levels recommended and adjust dose accordingly.

Refer to renal pharmacist for advice on dosing in haemodialysis and peritoneal dialysis.

Refer to critical care pharmacist for advice on dosing in CVVH.

Page last edited: 28/04/2009

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.