General Toxicity Notes
Nephrotoxic, ototoxic. Toxicity worse when hyperbilirubinemic. Measure serum levels for efficacy and toxicity. Peritoneal absorption increases with presence of inflammation. Vd increases with edema, obesity, and ascites. Do not use once-daily dosing in patients with CrCl <30-40 mL/min or in patients with acute renal failure or uncertain level of kidney function.
Half-Life (Normalesrd) Hours
1.8/20-60
Plasma Protein Binding %
<5
Volume Of Distribution L/Kg
0.23-0.26
Dose For Normal Renal Function
1.7 mg/kg q8h or 5-7 mg/kg qd
Adjustment For Renal Failure Method
I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% q8-24h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% q12-48h by levels [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
100% q48-72h by levels [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: full dose after dialysis
Supplement For Dialysis [Recommendation Level]: Pd
PD: 3-4 mg/L/d
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, monitor levels, [A]
References
de Paepe M, Lameire N, Belpaire F, Bogaert M. Peritoneal pharmacokinetics of gentamicin in man. Clin Nephrol. 1983; 19: 107-9. [PMID: 6839558] / Ernest D, Cutler DJ. Gentamicin clearance during continuous arteriovenous hemodiafiltration. Crit Care Med. 1992; 20: 586-9. [PMID: 1572182] / Pancorbo S, Comty C. Pharmacokinetics of gentamicin in patients undergoing continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother. 1981; 19: 605-7. [PMID: 7247382] / Thomson AH, Grant AC, Rodger RS, Hughes RL. Gentamicin and vancomycin removal by continuous venovenous hemofiltration. DICP. 1991; 25: 127-9. [PMID: 2058183]