Aminoglycoside use in pregnant people

It is widely accepted that gentamicin can be safely used to treat serious infections in pregnancy (eg sepsis or septic shock, acute pyelonephritis), despite its category D classification by the Australian Therapeutic Goods AdministrationChean 2017Glaser 2015The Royal Women’s Hospital 2023. There are fewer data on the use of amikacin and tobramycin in pregnancy.

Appropriate aminoglycoside dosing in pregnant people is poorly defined; aminoglycoside plasma concentrations may be significantly altered by pregnancy-related increases in blood volume and kidney function. Dosing regimens using different weight metrics have been used in practice and reported in the literature, but not directly comparedMartingano 2018. In the absence of comparative data, it is appropriate to use lean body weight to calculate the aminoglycoside dose and the same dose recommendations as for other adult patients; for dosing information, see:

• Once-daily or less frequent aminoglycoside dosing for empirical and directed therapy in adults
• Multiple-daily aminoglycoside dosing for synergistic therapy in adults, children and neonates.

Careful monitoring of the aminoglycoside plasma concentration is needed to optimise efficacy and avoid toxicity. Consider monitoring from the first dose and seeking expert advice to optimise dosing.