Gentamicin - Renal dosing

Usual Dosing (Adults)

Dosing (Adults): I.M., I.V.: Systemic infections:
Severe, life-threatening infections:
Conventional dosing: 2-2.5 mg/kg/dose every 8-12 hours; to ensure adequate peak concentrations early in therapy, higher initial dosages may be considered in selected patients when extracellular water is increased (edema, septic shock, postsurgical, or trauma)

Once-daily dosing: Some clinicians suggest a daily dose of 4-7 mg/kg once daily for all patients with normal renal function; this dose is at least as efficacious with similar, if not less, toxicity than conventional dosing.

Urinary tract infections: 1.5 mg/kg/dose every 8 hours

Synergy (for gram-positive infections): 1 mg/kg/dose

Prevention of bacterial endocarditis:
Dental, oral, or upper respiratory procedures: 1.5 mg/kg (not to exceed 80 mg) with ampicillin (1-2 g) 30 minutes prior to procedure

GI/GU surgery: 1.5 mg/kg (not to exceed 80 mg) with ampicillin (2 g) 30 minutes prior to procedure

Renal Dosing

dialysis Dosing interval in renal impairment:
Conventional dosing:
Clcr >/=60 mL/minute: Administer every 8 hours
Clcr 40-60 mL/minute: Administer every 12 hours
Clcr 20-40 mL/minute: Administer every 24 hours
Clcr<20 mL/minute: Loading dose, then monitor levels

High-dose therapy: Interval may be extended (eg, every 48 hours) in patients with moderate renal impairment (Clcr 30-59 mL/minute) and/or adjusted based on serum level determinations.


dialysis Hemodialysis: Dialyzable; removal by hemodialysis: 30% removal of aminoglycosides occurs during 4 hours of HD; administer dose after dialysis and follow levels.


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