Gentamicin

Administer IV dose over 1 hour
Adjust dosing per kinetics if >1-2 days use
Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)

See Bacterial Conjunctivitis
Adult
1. Gentamicin 3 to 5 mg/kg/day divided every 8 hours IV or IM (FDA approved) OR
2. Gentamicin 5 to 7 mg/kg/dose IV every 24 hours (off label)
Child (age >1 month old, weight >2 kg)
1. Gentamicin 2 to 2.5 mg/kg/dose IV or IM every 8 hours (FDA approved) OR
2. Gentamicin 5 to 7 mg/kg/dose IV every 24 hours (off label)
Obesity
1. Base dose on average between the Ideal Body Weight and actual weight

See other references for preterm and Low Birth Weight Infants
Term Infant (age <1 week, weight >2 kg)
1. Gentamicin 2.5 mg/kg/dose IV or IM every 8 hours (FDA approved) OR
2. Gentamicin 4 mg/kg IV every 24 hours (off-label)
Term Infant (age 8 to 28 days, weight >2 kg)
1. Gentamicin 2 to 2.5 mg/kg/dose IV or IM every 8 hours (FDA approved) OR
2. Gentamicin 4 to 5 mg/kg IV every 24 hours (off-label)

See Urinary Catheter associated Urinary Tract Infection (CAUTI)
Indications (off label and uncommon use, but is used by urologists in some cases)
1. Prophylaxis of recurrent Urinary Catheter associated Urinary Tract Infection (CAUTI)
2. Treatment of CAUTI when systemic Antibiotics carry greater risk (e.g. recurrent C. difficile)
Compounding pharmacy
1. Prepare Gentamicin 480 mg in 1 Liter Normal Saline (0.48 mg/ml)
2. Divided into syringes each containing 50 ml solution (28.8 mg Gentamicin/syringe)
3. Allows patient or their Caregiver to instill individual doses at home
Instill into Bladder and plug or clamp catheter proximally
1. Patient lies supine for 1 hour
2. Drain Bladder after 1 hour
Frequency and duration (varies considerably across studies and is not standardized)
1. Treatment has been with irrigation twice daily for 7 days
2. Prophylaxis of recurrent CAUTI
  1. Frequency varies from daily to 2-3 times weekly
  2. Duration varies from 2-3 weeks to 3 months, 9 months and 24 months
References

Target levels for multiple daily dosing
1. Maintain Trough <2 mcg/ml
  1. Drawn immediately before next dose
2. Maintain Peak at 5 to 8 mcg/ml in adults (4 to 6 mcg/ml for child)
  1. Draw 1 hour after Intramuscular dose
Target levels for once daily dosing
1. Maintain peak level 15 to 20 mcg/ml
2. Maintain trough level <1 mcg/ml
Indications for drug levels followed by Pharmacist
1. See Aminoglycoside for Nephrotoxicity Risk factors
2. Aminoglycoside use over 3 days
3. Renal dysfunction
4. Burn Injury

See Aminoglycoside
Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
1. See Aminoglycoside for risk factors