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Dosing and monitoring of gentamicin
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Monitoring of aminoglycosides has been recommended routinely to minimise nephrotoxicity, as well as both vestibular and auditory ototoxicity.It is recommended for all patients in whom it is anticipated that aminoglycosides will be given for more than 2 days. The principal objective is to delay the onset of nephrotoxicity and reduce the risk of ototoxicity.
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Gentamicin dose and interval
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For patients with normal renal function:
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- 4-6mg/kg/day given once daily, EXCEPT in pregnant women and other patients with unconventional pharmacokinetics or endocarditis - for these patients use the same total daily dose, divided into 2-3 doses per day.
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For patients with abnormal renal function:
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Doses up to 240mg may be given by slow IV injection over 3-5 minutes.
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Higher doses are recommended to be given by IV infusion over 30-60 minutes.
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Monitoring of plasma levels
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For once daily dosing:
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- A single mesurement of plasma concentration should be made between 6 and 14 hours after the end of the infusion of the first dose. This plasma concentration is then compared to the graph below.
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Aminoglycoside plasma concentration versus time for once-daily dosing
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Dosage adjustment should be applied after the first dose. It should be repeated daily if the clinical state, especially renal function, is unstable and otherwise every 3-5 days.
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For further adjustment, refer to Antibiotic Therapeutic Guidelines
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For multiple daily dosing:
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- Measure peak and trough plasma levels. Plasma levels are done immediately before the third dose (trough) and 30 minutes after completion of the third dose (peak). This should be repeated every 3 to 5 days, or more frequently if renal function is unstable.
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- recommended trough level < 2 mg/L
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- recommended peak level > or = 8mg/L
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Reference
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- Antibiotic Therapeutic Guidelines 12th Edition, 2003
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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