Gentamicin

General

• Type: Aminoglycosides
• Dosage Forms: IM; IV
• Common Trade Names:

Adult Dosing

• All: If obese, use Adjusted Weight = IBW + 0.4 x (ABW - IBW)
• All: Adjust repeat dosing based on levels

General

• Extended Interval
  • 5-7mg/kg IV q24h
  • First Dose: 5-7mg/kg IV
• Conventional
  • 1-1.7mg/kg IM/IV q8h

Uncomplicated Gonococcal

• 240mg IM x 1

Severe PID

• 1.5mg/kg IM/IV q8h
  • Start 2mg/kg IM/IV x 1
• Alt: 3-5mg/kg IM/IV q24h
• Info: Give with clindamycin

Pediatric Dosing

• All: adjust repeat dosing based on levels

General (<8 Days Old)

• First Dose All: 2.5mg/kg IV/IM x1
• <28 weeks gestation
  • 2.5mg/kg IV/IM q24h
  • Alt: 5mg/kg IV/IM q48h
• 28-29 weeks gestation
  • 2.5mg/kg IV/IM q18h
  • Alt: 5mg/kg IV/IM q48h
• 30-33 weeks gestation
  • 2.5mg/kg IV/IM q18h
  • Alt 1: 3.5mg/kg IV/IM q24hr
  • Alt 2: 4.5mg/kg IV/IM q36-48h
• 34 weeks gestation
  • 2.5mg/kg IV/IM q18h
  • Alt 1: 3.5mg/kg IV/IM q24hr
  • Alt 2: 4mg/kg IV/IM q24-36h
• 35-36 weeks gestation
  • 2.5mg/kg IV/IM q 12h
  • Alt 1: 3.5mg/kg IV/IM q24
  • Alt 2: 4mg/kg IV/IM q24-36h
• Full Term
  • 2.5mg/kg IV/IM q12h
  • Alt: 4mg/kg IV/IM q24h

General (8 Days - 1 Month)

• First Dose All: 2.5mg/kg IV/IM x1
• <30 weeks gestation
  • 2.5mg/kg IV/IM q18h
  • Alt: 4mg/kg IV/IM q24-36h
• 30-33 weeks gestation
  • 2.5mg/kg IV/IM q12h
  • Alt: 4mg/kg IV/IM q24
• 34 weeks gestation
  • 2.5mg/kg IV/IM q12h
  • Alt: 4mg/kg IV/IM q18h
• 35-36 weeks gestation
  • 2.5mg/kg IV/IM q8h
  • Alt: 4mg/kg IV/IM q12h
• Full term
  • 2.5mg/kg IV/IM q8h
  • Alt: 4mg/kg IV/IM q24h

General (1 Month -6 Months)

• 2.5mg/kg IV/IM q8h
• Alt: 6.5mg/kg IV/IM q24h

General (>6 Months)

• 2.5mg/kg IV/IM
• Alt: 6.5-7.5mg/kg IV/IM q24h
• Use IBW if >2yo

Special Populations

• Pregnancy Rating: D
• Lactation: Probably safe
• Renal Dosing
  • Adult
    • Conventional interval dosing
      • CrCl 10-50: give q12-48h
      • CrCl <10: give q48-72h
      • Hemodialysis: give 1-1.7mg/kg after dialysis
    • Extended interval dosing
    • CrCl 30-60: increase dosing interval based on levels
    • CrCl <30: avoid use
  • Pediatric
    • Conventional interval dosing
      • CrCl 30-50: give q12-48h
      • CrCl: 10-29: Give q18-24h
      • CrCl <10: give q48-72h
      • Hemodialysis/peritoneal dialysis: give 2mg/kg after dialysis
    • Extended interval dosing
    • CrCl 30-60: increase dosing interval based on levels
    • CrCl <30: avoid use
• Hepatic Dosing (Adult & Pediatric)
  • Not defined

Contraindications

• Allergy to class/drug

Pharmacology

• Half-life:
• Metabolism:
• Excretion:
• Mechanism of Action:

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	R
	Strep. Pneumoniae	R
	Viridans strep	X1
	Strep. anginosus gp	X1
	Enterococcus faecalis	S
	Enterococcus faecium	S
	MSSA	S
	MRSA	R
	CA-MRSA	X1
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	R
	N. meningitidis	R
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	X1
	Serratia marcescens	S
	Salmonella sp	X1
	Shigella sp	S
	Proteus mirabilis	X1
	Proteus vulgaris	S
	Providencia sp.	X1
	Morganella sp.	X1
	Citrobacter freundii	X1
	Citrobacter diversus	X1
	Citrobacter sp.	X1
	Aeromonas sp	X1
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	S
	Brucella sp.	S+'
	Legionella sp.	X1
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	I
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	X1
Anaerobes	Actinomyces	R
	Bacteroides fragilis	R
	Prevotella melaninogenica	R
	Clostridium difficile	R
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	R
	Peptostreptococcus sp.	R

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)

Source

Authors

Ross Donaldson, Neil Young, Daniel Ostermayer