An aminoglycoside antibiotic given IV or IM for serious infections, especially from gram-negative bacteria such as Pseudomonas and E. coli. It can damage the kidneys and the inner ear, sometimes permanently, so peak and trough blood levels, kidney function, and hearing are monitored.
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Narrow therapeutic index. The label directs measuring peak and trough serum gentamicin concentrations to keep doses effective and avoid toxic levels, adjusting to avoid prolonged peaks above 12 mcg/mL and troughs above 2 mcg/mL.
Nephrotoxicity and neurotoxicity. Gentamicin can damage the kidneys and both the hearing and balance branches of the eighth cranial nerve; ear damage is usually irreversible. Risk rises with renal impairment, high doses, prolonged therapy, older age, dehydration, and other nephrotoxic or ototoxic drugs. Monitor renal function and eighth nerve function, and serum levels when feasible: avoid prolonged peaks above 12 mcg/mL and troughs above 2 mcg/mL. Avoid potent diuretics such as furosemide. Aminoglycosides can harm the fetus.
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No specific antidote. Hemodialysis helps remove gentamicin in overdose or toxicity, especially with poor renal function; peritoneal dialysis removes much less. Exchange transfusion may be considered in newborns. Calcium salts may reverse neuromuscular blockade.
Doses come from the FDA label. Study tool, not for clinical decisions.
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Must be adjusted. One guide: extend the interval in hours to about 8 times the serum creatinine (mg/dL), or divide the usual dose by the serum creatinine and keep 8-hour dosing. Follow peak and trough levels, since renal function can change during the infection.
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A bactericidal aminoglycoside that inhibits normal protein synthesis, active against Pseudomonas aeruginosa, Proteus, E. coli, Klebsiella-Enterobacter-Serratia, Citrobacter, and staphylococci. It is synergistic with cell wall agents such as penicillin against enterococci. It distributes in extracellular fluid, is barely metabolized, and is excreted by glomerular filtration; clearance falls with renal impairment, and a small amount is retained in renal tissue.