Initial extended-interval aminoglycoside dose and dosing interval in adults

Creatinine clearance (mL/min/70 kg)^*	Gentamicin or tobramycin^¶	Amikacin
≥ 60	7 mg/kg every 24 hours	15 to 20mg/kg every 24 hours
40 to 59	7 mg/kg every 36 hours	15 mg/kg every 36 hours
30 to 39	7 mg/kg every 48 hours	15 mg/kg every 48 hours
<30^Δ or renal replacement therapy (IHD, CRRT)	Use traditional/conventional dosing rather than extended interval dosing

The maintenance dose and dosing intervals are best determined by monitoring serum drug concentrations following the initial dose. Extended interval aminoglycoside dosing is not recommended for particular indications and populations. As an example, the doses listed in this table do not apply to aminoglycosides being used as synergistic therapy for gram positive infections. Refer to other UpToDate content on dosing of aminoglycosides for other exclusions and additional details.

* Creatinine clearance may be estimated by use of Cockroft-Gault equation. Calculators for estimation of creatinine clearance are available in UpToDate.

¶ For patients postpartum endometritis or open fracture infections, an initial dose of 5mg/kg can be used; however, plotting concentrations on the Hartford Nomogram based on these regimens will not provide accurate drug clearance estimates.

Δ Some institutions use a lower threshold of 20 to 30 mL/min for using traditional intermittent instead of extended interval dosing. In such cases, for patients who have a creatinine clearance between this lower limit and 40 mL/min, the calculated aminoglycoside dose is administered at a 48-hour interval.

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Initial extended-interval aminoglycoside dose and dosing interval in adults