gentamicin

Adult Dosing .

Dosage forms:  INJ

infections, bacterial

[conventional interval dosing]

Dose: 1-1.7 mg/kg/dose IM/IV q8h; Info: use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels

[extended interval dosing]

Dose: 5-7 mg/kg/dose IV q24h; Info: not indicated in pregnancy, burns, ascites, obesity, neutropenia or endocarditis; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on random serum levels and nomogram

endocarditis, gram positive synergy

[3 mg/kg/dose IV q24h for at least 2wk]

Alt: 1 mg/kg/dose IV q8h for at least 2wk; Info: dose, duration varies w/ pathogen susceptibility, valve type; part of multi-drug regimen; refer to AHA guidelines; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels

infections, uncomplicated gonococcal

[240 mg IM x1]

Info: for infections of cervix, urethra, rectum; not 1st-line agent; give w/ azithromycin

PID, severe

[3-5 mg/kg/dose IM/IV q24h x14 days]

Alt: 2 mg/kg/dose IM/IV x1, then 1.5 mg/kg/dose IM/IV q8h x14 days; Info: give w/ clindamycin; not-1st line agent; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels; switch to PO regimen ASAP to complete course

pneumonia, hospital-acquired

[5-7 mg/kg/dose IV q24h x7 days]

Info: may extend duration based on clinical response; refer to IDSA guidelines; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels

pneumonia, ventilator-assoc.

[IV route]

Dose: 5-7 mg/kg/dose IV q24h x7 days; Info: may extend duration based on clinical response; refer to IDSA guidelines; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels

[NEB route (off-label)]

Dose: 80 mg NEB q12h x7 days; Info: for adjunct tx; may extend duration based on clinical response; refer to IDSA guidelines

UTI

[5-7 mg/kg/dose IV x1]

Info: for pyelonephritis; to complete tx, give ciprofloxacin, levofloxacin, or sulfamethoxazole/trimethoprim; refer to IDSA guidelines; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts

infection prophylaxis, surgical (off-label)

[5 mg/kg/dose IV x1]

Start: w/in 60min preop; Info: use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts

brucellosis (off-label)

[5 mg/kg/dose IM/IV q24h x7-10 days]

Info: part of multi-drug regimen; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels

renal dosing

[NEB route]

renal impairment: not defined

HD/PD: not defined

[conventional interval dosing]

CrCl 10-50: give usual dose q12-24h; CrCl <10: give usual dose x1, then redose if serum levels <1-2 mg/mL; Info: adjust dose, frequency based on serum levels

HD: give usual dose x1, then redose after dialysis if serum levels <1-2 mg/mL; no supplement; PD: not defined; Info: adjust dose, frequency based on serum levels

[extended interval dosing]

CrCl 30-60: adjust frequency based on random serum levels and nomogram; CrCl <30: avoid extended interval dosing; consider conventional interval dosing

HD: avoid extended interval dosing; consider conventional interval dosing; PD: not defined

[synergy dosing, q8h]

CrCl <60: give usual dose q12-24h; Info: adjust dose based on serum levels

HD: give usual dose x1, then redose if serum levels <1 mg/mL; no supplement; PD: not defined; Info: adjust dose based on serum levels

[synergy dosing, q24h]

renal impairment: not defined

HD/PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  INJ

bacterial infections, neonatal dosing

[<30 wk gestation, 0-7 days old]

Dose: 5 mg/kg/dose IV q48h; Info: adjust dose based on serum levels

[<30 wk gestation, 8-28 days old]

Dose: 4 mg/kg/dose IV q36h; Info: adjust dose based on serum levels

[<30 wk gestation, 29 days old and older]

Dose: 4 mg/kg/dose IV q24h; Info: adjust dose based on serum levels

[30-34 wk gestation, 0-7 days old]

Dose: 4.5 mg/kg/dose IV q36h; Info: adjust dose based on serum levels

[30-34 wk gestation, 8 days old and older]

Dose: 4 mg/kg/dose IV q24h; Info: adjust dose based on serum levels

[35 wk gestation and older, 0-28 days old]

Dose: 4 mg/kg/dose IV q24h; Info: adjust dose based on serum levels

bacterial infections, conventional interval dosing

[1 mo and older]

Dose: 2.5 mg/kg/dose IV q8h; Info: adjust dose based on serum levels; consider using IBW in pts 1 mo and older

bacterial infections, extended interval dosing

[3 mo-2 yo]

Dose: 9.5 mg/kg/dose IV q24h; Info: adjust dose based on serum levels

[2-8 yo]

Dose: 8.5 mg/kg/dose IV q24h; Info: adjust dose based on serum levels

[8 yo and older]

Dose: 7 mg/kg/dose IV q24h; Info: adjust dose based on serum levels

endocarditis, gram positive synergy

[3-6 mg/kg/day IV divided q8h]

Info: dose, duration varies w/ pathogen susceptibility, valve type, sx duration; part of multi-drug regimen; refer to AHA guidelines; adjust dose based on serum levels

infections, uncomplicated gonococcal

[adolescents]

Dose: 240 mg IM x1; Info: for infections of cervix, urethra, rectum; not 1st-line agent; give w/ azithromycin

PID, severe

[adolescents]

Dose: 3-5 mg/kg/dose IM/IV q24h x14 days; Alt: 2 mg/kg/dose IM/IV x1, then 1.5 mg/kg/dose IM/IV q8h x14 days; Info: give w/ clindamycin; not-1st line agent; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels; switch to PO regimen ASAP to complete course

UTI

[2 mo-2 yo]

Dose: 7.5 mg/kg/day IV divided q8h x7-14 days; Info: duration varies w/ infection type, severity; adjust dose based on serum levels; consider using IBW

infection prophylaxis, surgical (off-label)

[1 yo and older]

Dose: 2.5 mg/kg/dose IV x1; Start: w/in 60min preop

brucellosis (off-label)

[8 yo and older]

Dose: 5 mg/kg/dose IM/IV q24h x7-10 days; Info: part of multi-drug regimen; adjust dose based on serum levels

renal dosing

[neonatal dosing]

renal impairment: not defined; Info: adjust dose based on serum levels

HD/PD: not defined; Info: adjust dose based on serum levels

[conventional interval dosing]

CrCl 10-50: give usual dose q12-24h; CrCl <10: give usual dose q48-72h; Info: adjust dose based on serum levels

HD: give usual dose x1, then adjust dose based on serum levels; no supplement; PD: not defined

[extended interval dosing]

CrCl 30-60: adjust frequency based on serum levels; CrCl <30: avoid extended interval dosing; consider conventional interval dosing

HD: avoid extended interval dosing; consider conventional interval dosing; PD: not defined

[synergy dosing]

renal impairment: consider adult renal dosing for guidance

HD/PD: consider adult renal dosing for guidance

hepatic dosing

[not defined]