Monitoring aminoglycocide with narrow therapeutic index and high risk for ototoxicity and neurotoxicity.

Gentamicin can be requested as:

Neonatal Gentamicin (22 hours post dose, for neonates to 30 days only).

Pre-Dose - 30 minutes before the following dose (do not delay administration of the next dose)

Post Dose - 6 hours after a dose of gentamicin.

Random - only on Pharmacy/ Infectious Diseases Unit advice.

AUC calculations are not provided by the pathology laboratory.

Request must specify dose, route, time(s) of dose/infusion and sample collection time

Monitoring:

Pre and post dose levels are applicable only to patients with endocarditis [dosing usually tds (8 hourly) but occasionally bd (12 hourly) or once daily].

For once daily dosing (non-endocarditis), both levels are 'post' (at 30 minutes and 6 hours after the dose).

Random gentamicin levels may be performed if requested, as advised by pharmacy.

Angliss, Box Hill and Maroondah pharmacy staff will calculate appropriate dosing using these levels and recommend dose adjustment if required. Contact pharmacy for this service.

All Gentamicin requests on neonates from Angliss must be treated as URGENT and sent via taxi directly to BHH for analysis.

22 hour Gentamicin should be performed after the second dose of gentamicin. Recommended dosing interval after this:
<1.2mg/L  every 24 hours after previous dose
1.3-2.6mg/L  every 36 hours after previous dose
2.7-3.5mg/L  every 48 hours after previous dose
>3.6mg/L  hold dose, repeat concentration 24 hours later 
(Refer to ANMF consensus group guidelines for gentamicin in newborns)

Paediatrics: Refer to Royal Children's Hospital Guidelines and liaise with pharmacy for dosage adjustments and further monitoring

Adults:  Refer to EH policy 3547 "Intravenous Aminogylcosides Guideline" and liaise with pharmacy for dosage adjustments and further monitoring