Amino glycoside

Prepared by:

Mohamed Alaa Adel Elbosaty

Majid Mahmoud Hussain Allaithy

drugs nephrotoxicity Dose adjustment note

Gentamicin CrCL (mL/min) adjustment Initial Monitoring • Random level

/ ≥ 60 mL/min 7 mg/kg Q24H drawn 8 – 12 hours after the first dose
Tobramycin • Use nomogram to confirm/modify
40 – 59 mL/min 7 mg/kg Q36H dosage interval • Hartford nomogram is
30 – 39 mL/min 7 mg/kg Q48H only applicable for 7 mg/kg – plotting
20 – 29 mL/min Not recommended doses lower or higher than 7 mg/kg
may under or overestimate clearance
< 20 mL/min Not recommended
➢ Gentamicin/tobramycin (7
Hemodialysis Not recommended mg/kg/dose): Plot level on graph ➢
no oliguric CRRT Not recommended Amikacin (15 mg/kg/dose): Divide level
in half, then plot on graph
renal failure, Follow up trough level testing • An
with a slow early trough (6-hours prior to dose)
rise in serum should be considered in patients
demonstrating acute changes in renal
creatinine and function or suspicion of extended
a hypo- interval failure. Aiming for a level < 1
osmolar mcg/mL approximately 6-hours prior to
urinary output the next dose ensures there is a drug-
free window in order to minimize drug
developing accumulation within the proximal
after several tubules. • Maintenance random levels
days of should be monitored at least once
weekly. • If duration of therapy is
treatment anticipated to be > 2 weeks,
audiometry should be considered
Amikacin CrCL (mL/min) adjustment
≥ 60 mL/min 15 mg/kg Q24H

40 – 59 mL/min 15 mg/kg Q36H

30 – 39 mL/min 15 mg/kg Q48H

20 – 29 mL/min Not recommended
< 20 mL/min Not recommended

Hemodialysis Not recommended

CRRT Not recommended