Gentamicin

Renal Directorate Guidelines

Royal Infirmary of Edinburgh – NHS Lothian


Gentamicin in Haemodialysis

Indication

  • Empirical antibiotic with vancomycin for line sepsis (review ongoing need when culture results are available)
  • All other indications as per NHS Lothian Antimicrobial guideline

Dosage and administration

  • 2mg/kg

 (Please use dry weight. This is particularly important in patients with oedema)

**Do NOT use Gentamicin Calculator on the Intranet**

  • Please administer via a central venous catheter or a large vein if only peripheral access is available.

Concentration/strength

  • 80mg/2ml or diluted for infusion

 

Stability

 

  • Please use reconstituted solution as soon as possible.

Reconstitution instructions

  • IV injection – to be administered over 5 minutes

Can be given undiluted (40mg/ml) or diluted in 10-20ml of sodium chloride 0.9% or glucose 5% to aid slow bolus injection.

  • IV infusion – to be infused over 20 minutes

Dilute in 100ml of sodium chloride 0.9% or glucose 5%

 

Additional Information:

  • Haemodialysis (HD) removal: Yes
  • Haemodiafiltration (HDF) removal: Yes
  • Dose should be administered after dialysis
Monitoring:
Inpatients Outpatients

Dialysis days

  • Take a level pre-dialysis
  • Dose to be administered if level is <3mg/l

Non-dialysis days

  • Please take a level before the expected dosing time
  • Dose to be administered if level is <2mg/l

Peak level after dose administration

  • Take a peak level ONE HOUR AFTER the end of dose administration
  • Target peak is 8 to 12mg/l. Please discuss dose adjustment with Renal pharmacist if target not achieved
  • No further dose change is required when two therapeutic peak levels are achieved unless clinically indicated.

  • Take a level pre-dialysis
  • Dose to be administered if level is <3mg/l
For NEW patients starting on gentamicin, a pre-dialysis level is not required prior to the first dose

 

Written by: Dr Ailish Nimmo, Specialist Registrar, Renal Pharmacist
Reviewed by: Dr Iain MacIntyre, Consultant Nephrologist
Date written: January 2018
Review date: January 2020

 

 

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