ADJUNCTIVE ONCE-DAILY GENTAMICIN (3 mg/kg) FOR INFECTIVE ENDOCARDITIS

• Infective endocarditis - See Infective Endocarditis guideline
• empirical starting regimen before bacteria isolated
• for Staphylococcal, Streptococcal and Enterococcal infective endocarditis
• In combination with an appropriate beta-lactam or glycopeptide antibiotic

• Check patient currently not receiving nor has recently received therapeutic gentamicin doses
• If any concerns about nephrotoxicity, seek advice from Consultant Microbiologist/ID
• Peak (one-hour post-dose) levels do not require monitoring

• If pre-dose (trough) levels allow, give gentamicin 3mg/kg IV 24-hrly

• Weigh patient
• if unfit to be weighed, estimate weight
• Lowest weight [actual (or estimated) or ideal] is used to select dose

• Gentamicin is supplied as a 40mg/ml solution for injection
• Administer a slow bolus over 5 min
• Record time bolus started on drug chart

• Take blood for pre-dose gentamicin level
• wait for levels

Pre-dose (trough) level <1 mg/L

• Give next dose
• lowest weight [actual (or estimated) or ideal] is used to select dose

Pre-dose (trough) level ≥ 1mg/L

• Repeat level check 12 hrly
• omit further doses until level <1mg /L
• when pre dose (trough) level <1 mg/L, give next dose

Pre-first dose (trough) level <1 mg/L

• Re-check trough levels after a further 2-3 doses

Pre-first dose (trough) level ≥ 1mg/L

• Check trough level before every dose