Normal renal function

1
Starting dose
Normal renal function 5 mg/kg (max. 500
mg) (round to nearest 40 mg)
Patient gt70 years OR estimated GFR 20-40
ml/min 3 mg/kg (round to nearest 40 mg)
Significant renal impairment Estimated GFR lt 20
ml/min 2 mg/kg (round to nearest 40 mg)
Stat dose only Level after 18-24 hours Await
results before considering further dose(s)
Day 1
Start time of 1st dose
1st dose given between 4 am and 8 pm
1st dose given between 8 pm and 4 am
Guide to Once Daily Gentamicin Dosing - NUH
Clinical Haematology Unit
4am2pm
2pm-8pm
Blood sample1 at 10 pm
Blood sample1 at 8 am
Blood sample1 at 2 pm
Day 2

• Notes
• A pre-dose gentamicin level should be taken
  18-24 hours after the 1st dose. Target value is lt
  1 mg/L. Post-dose samples are not required.
• The 2nd dose can be administered before the assay
  results are available to patients with stable
  renal function and good urine output.

2nd subsequent doses2 at 10 pm (after level)
2nd subsequent doses2 at 2 pm (after level)