Aminoglycoside use in patients with kidney impairment

For adults with creatinine clearance less than 60 mL/minute, a single empirical aminoglycoside dose is generally safe and can be lifesaving, but subsequent dosing requires careful consideration. Consider an alternative antimicrobial in patients who are not critically ill and have a creatinine clearance less than 20 mL/min.

Although repeated once-daily aminoglycoside dosing for patients with chronic kidney impairment is well accepted by many clinicians, repeat doses should not be used in these patients unless there are no alternatives, and it is recommended by an expert.

If more than a single aminoglycoside dose is administered, careful monitoring is required to optimise efficacy and avoid toxicity.

When kidney impairment is caused by sepsis, repeat dosing may be appropriate because kidney function often improves with effective treatment. However, if kidney impairment persists or worsens, further aminoglycoside doses may be inappropriate; an alternative antibiotic should be considered. Expert advice may be required.

Dialysis (eg intermittent haemodialysis, continuous renal replacement therapy [CRRT], sustained low-efficiency dialysis [SLED]) can markedly alter aminoglycoside pharmacokinetics. Dosing and monitoring is difficult in these patients. Consider using AUC-based model-informed precision dosing software, or an alternative antibiotic; seek expert advice.

For neonates and children with kidney impairment, seek expert advice.