- Antibiotic for the treatment of serious infections caused by susceptible bacteria (primarily gram negative)
- Stable at room temperature
- Available as a 40 mg/mL solution
- Vial stable 30 days refrigerated once punctured
- Diluted solutions stable 48 hours refrigerated or at room temperature
- Solutions Compatible: dextrose concentrations up to D10W, 0.9% NaCl, ringer's solution
- Additives/Above Cassette Compatible: clindamycin
- Y-site Compatible: heparin (0.5 - 1 unit/mL), morphine, KCl, TPN (amino acids/dextrose)
- Incompatible: heparin (greater thatn 1 unit/mL), azithromycin, furosemide, propofol; Do not mix with beta lactam antibiotics. Flush line well between administration of beta lactams and aminoglycoside antibiotics .
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES |
| IV Direct | NO |
| IV Intermittent Infusion |
YES |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric/Adolescent:
Traditional dosing : 7.5 mg/kg/day divided Q8H. Maximum 120 mg/dose if no previous levels
Single daily dosing : 7 mg/kg/day Maximum 360 mg / dose if no previous levels
Combination therapy for synergy in selected infections : 3 mg/kg/day divided Q8H Maximum 80 mg/dose before levels
Febrile Neutropenia Pediatric/Adolescent:
Once daily dosing: 7.5 mg/kg/dose - NO MAXIMUM DOSE
-Calculate dose based on actual body weight unless the patient weighs greater than or equal to 125% of ideal body weight, in which case the dose is based on the effective body weight.
Click here to go to Lexicomp online to calculate the Ideal Body Weight. From this page, type in "ideal body weight "in the lookup box, click on lookup tab and choose either Ideal Body Weight: Adult for patients over 60 inches or Ideal Body Weight: Pediatric for patients less than 60 inches (152.4 cm)
Dose interval adjustment in renal impairment with traditional dosing:
CrCl 40-60 mL/minute: Administer Q 12 hours
CrCl 20-39 mL/minute: Administer Q 24 hours
CrCl < 20 mL/minute: Administer normal dose, then monitor levels
Adjust regimen based on serum concentrations
- Hypersensitivity reactions [urticaria, rash, hives, pruritis, fever (rare)]
- Ototoxicity (vertigo, hearing loss, tinnitus, dizziness)
- Nephrotoxicity (proteinuria, reduction in GFR, elevated serum creatinine)
- Potential for neuromuscular blockade (rare)
Adverse effects are potentiated by other ototoxic or nephrotoxic drugs
- Apnea may result when combined with anesthetics or other neuromuscular blocking drugs
- Maintain good hydration, baseline serum creatinine and repeat once weekly, caution in patients with impaired renal function
- An audiology consult is recommended if IV aminoglycoside therapy is expected to continue for 14 days. Repeat every 7 days if therapy continues.
Therapeutic Drug Monitoring:
When checking level, administer next dose as scheduled. Do not wait for levels to be reported unless otherwise advised
|
Traditional Dosing: Therapeutic Serum Concentration |
PRE (Trough): less than 2 mg/L |
|
POST (Peak): |
|
|
Traditional Dosing : Sampling Time |
PRE: 0 - 30 minutes prior to next dose |
|
POST: 30 minutes after end of 30 minute infusion |
|
Single Daily Dosing: - Initial level on Day 3 and repeat once weekly |
Measure PRE only |
| Combination therapy for synergy: - Initial level on Day 3 and repeat once weekly |
Measure PRE only - 0 - 30 minutes prior to next dose - less than 0.3 mg/L |