Recommended loading dose for traditional, intermittent dosing of gentamicin or tobramycin in adults

Site of infection or indication	Desired peak concentration		Loading dose, mg/kg*^¶^Δ
Site of infection or indication	Conventional unit	SI unit	Loading dose, mg/kg*^¶^Δ
Gentamicin synergy with beta-lactams for treatment of serious gram-positive infections outside of the central nervous system^◊	3 to 4 mcg/mL	6 to 8.5 micromol/L	1 (initial dose, not a loading dose)
Uncomplicated lower urinary tract infection (ie, acute simple cystitis)	2 to 4 mcg/mL	4 to 8.5 micromol/L	1 (initial dose, not a loading dose)
Gram-negative sepsis or other serious gram-negative infections, including pseudomonal infection, gram-negative pneumonia, and acute life-threatening gram-negative infection in a critically ill patient^§	7 to 10 mcg/mL	14 to 21 micromol/L	2.5 to 3

These loading doses are used when a traditional, intermittent dosing strategy is being employed. For many patients, the preferred dosing strategy is extended-interval. Refer to aminoglycosides topic discussion of selection of dosing strategy.

* The loading dose is not adjusted for renal impairment.
¶ For overweight or obese patients, ideal body weight or dosing weight (respectively) should be used for scaling dose. A calculator to determine ideal body weight and dosing weight is available in UpToDate.
Δ These loading dose recommendations do not apply to special populations (ie, pregnant women, patients with ascites, severe burns, critical illness, fluid overload, cystic fibrosis) who may have altered aminoglycoside pharmacokinetics. A modified loading dose and approach to dose adjustment may be needed. Refer to topic discussion.
◊ Higher target peak concentrations are sometimes used for certain gram-positive central nervous system infections in an attempt to achieve concentrations at the site of infection that are adequate for synergy, but the optimal serum peak concentrations for this are uncertain.
§ Aminoglycosides should generally not be used as single agent therapy for serious infections due to typical gram-negative rods. Exceptions include urinary tract infections, tularemia, and plague.

This table lists doses recommended by UpToDate contributors based on pharmacokinetic data and institutional experience.

Graphic 79468 Version 8.0

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Recommended loading dose for traditional, intermittent dosing of gentamicin or tobramycin in adults