Standard Dosing:
Because of their critical therapeutic effect and side effect profile, it is recommended that parenteral aminoglycoside antibiotic therapy (gentamicin, tobramycin, netilmicin, andamikacin) be monitored by appropriate serum levels in most patients and dosage adjustments made if needed.
Aminoglycoside serum levels are generally required in all patients receiving aminoglycoside therapy, EXCEPT those patients with normal hearing and renal function receiving therapy for 72 hours or less (such as surgical prophylaxis), or for uncomplicated urinary tract infections.Drug serum levels (peak and trough) should be ordered during the first three days of therapy and repeated after 5-7 days, depending on the planned length of therapy, or in response to changes in the patient's clinical condition or renal function. Clinical pharmacists will continue to monitor the serum level results and provide recommendations for adjustment, if necessary, to the physician.
Extended Interval Dosing
Select patients are candidates for extended interval aminoglycoside dosing.The following populations are excluded:

CrCl < 40mL/min or changing renal function Neonates and Pediatics <12 yo Burns Aminoglycoside usage for synergy Pregnancy Renal failure and renal dialysis patients Quadraplegic, amputee Changing renal function Ascites or other significant third spacing Hemodynamically unstable Cystic fibrosis

Initial monitoring: For patients receiving 5 mg/kg dose: Check trough level prior to second dose. If trough < 0.5µg/ml:Continue therapy as ordered. If trough > 0.5µg/ml:Order two levels approximately 6 hours apart following second dose to determine clearance & Change to conventional therapy based on calculated clearance. Therapeutic monitoring: Monitor serum creatinine three times weekly. In patients with stable creatinine, recheck trough Q7Days. If creatinine increases by 0.5mg/dL, repeat trough & adjust regimen as above
For patients receiving 7 mg/kg dose: Monitoring should include a single level at 6-14 hours after the first dose. Therapeutic monitoring should include monitoring of serum creatinine three times weekly with repeat trough levels based on changes in renal function and length of therapy. A nomogram is available from the pharmacy for initial dosing adjustments in patients receiving a 7 mg/kg dose and additional monitoring guidelines may be recommended by the clinical pharmacists.