Gentamicin
CrCl
(ml/min)
>60
40-59
30-39
Intermittent HD
CRRT
CAPD
Gentamicin
not recommended
5-7 mg/kg q 48 h
5-7 mg/kg q 36 h
5-7 mg/kg q 24 h
not recommended
??
<30
Not recommended
Contraindications for High-Dose Extended-Interval Dosing: Pregnancy, Burn > 20%BSA, Large ascites, endocarditis (Please use conventional dosing.)
Conditions | Dose |
|---|---|
CrCl > 60 ml/min | 5 - 7 mg/kg q24h |
CrCl 40 - 59 ml/min | 5 - 7 mg/kg q36h |
CrCl 30 - 39 ml/min | 5 - 7 mg/kg q48h |
CrCl 20 - 29 ml/min | Not recommended |
CrCl < 20 ml/min | Not recommended |
Hemodialysis | (see conventional dosing) |
CAPD (peritonitis) | 0.6 mg/kg IP once daily |
CRRT | (see conventional dosing) |
SLED | (see conventional dosing) |
Contraindications for High-Dose Extended-Interval Dosing: Pregnancy, Burn > 20%BSA, Large ascites, endocarditis (Please use conventional dosing.)
Conditions | Dose |
|---|---|
CrCl > 60 ml/min | 1 mg/kg q8h |
CrCl 40 - 59 ml/min | 1 mg/kg q12h |
CrCl 30 - 39 ml/min | 1 mg/kg q24h |
CrCl 20 - 29 ml/min | 1 mg/kg q24h |
CrCl < 20 ml/min | 1 mg/kg once then dose by level |
Hemodialysis | 1 mg/kg load q48-72h (dose AD) |
CAPD (peritonitis) | 0.6 mg/kg IP once daily |
CRRT | 1 mg/kg q24h then by level |
SLED | No data |
Infective endocarditis (ESC guideline) CrCl > 60 only!!
** Streptococci, Streptococcus gallolyticus (bovis), Streptococcus viridans endocarditis: optional dosing 3 mg/kg q24h for CrCl > 60 mL/min
** Staphylococci; Enterococcus spp (strains susceptible to PCN and gentamicin) endocarditis: optional dosing 3 mg/kg q24h.
Conditions | Dose |
|---|---|
CrCl > 60 ml/min | 1.7 mg/kg q8h |
CrCl 40 - 59 ml/min | 1.7 mg/kg q12h |
CrCl 30 - 39 ml/min | 1.7 mg/kg q24h |
CrCl 20 - 29 ml/min | 1.7 mg/kg q24h |
CrCl < 20 ml/min | 2 mg/kg once then dose by level |
Hemodialysis | 1.7-2 mg/kg q48h +0.85-1.0 mg/kg AD |
CAPD (peritonitis) | 2 mg/kg IP once daily |
CRRT | 1.7-2.0 mg/kg q24h |
SLED | 6 mg/kg q48h 30min before SLED |
The Cockcroft-Gault equation may yield inaccurate estimates based on a patient's body weight and BMI. By including additional height information, we can calculate BMI and provide a modified estimate and range.
- Underweight: For a BMI of 18.5 or less, use the actual body weight for calculations.
- Normal Weight: Use the ideal body weight for calculations.
- Overweight/Obese: For a BMI of 25 or higher, use the adjusted body weight for calculations.
Calculation Steps
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