Indications for aminoglycoside plasma concentration monitoring

Aminoglycoside plasma concentration monitoring ensures adequacy of dosing and avoids excessive drug exposure, which can be associated with nephrotoxicity, and occasionally vestibular and auditory toxicity.

In patients receiving aminoglycoside therapy, prescribers must be able to monitor kidney function and, if therapy will continue for more than 48 hours, measure the aminoglycoside plasma concentration. As with other potentially toxic drugs, appropriate hospital policies should be in place to guide use of aminoglycosides.

Aminoglycoside plasma concentration monitoring is generally not required for empirical therapy that will be stopped within 48 hours.

In adults, consider monitoring from the first dose in patients with rapidly or substantially changing kidney function (eg critically ill patients with sepsis, patients with suspected acute kidney failure) and in adults with altered pharmacokinetics because drug exposures in these patients are difficult to predict.

Aminoglycoside plasma concentration monitoring in adults is mandatory from the first dose if directed therapy is expected to continue for more than 48 hours.

In neonates and children, aminoglycoside plasma concentration monitoring is not required for empirical therapy that will be stopped within 48 hours. For directed therapy that is expected to continue for more than 48 hours, plasma concentration monitoring is required once steady state has been reached. Earlier monitoring (ie from the first or second dose) may be considered in selected patient groups (eg patients with cystic fibrosis, patients with altered pharmacokinetics).

The approach to aminoglycoside plasma concentration monitoring depends on the frequency of dosing. For patients receiving an aminoglycoside once-daily or less frequently, see plasma concentration monitoring for once-daily or less frequent dosing in adults, children and neonates. For patients receiving multiple-daily dosing of an aminoglycoside, see Multiple-daily aminoglycoside dosing for synergistic therapy: plasma concentration monitoring in adults, children and neonates.