Aminoglycosides in Critically Ill Patients

• Aminoglycosides remain an important class of antibiotics in critically ill patients, especially those infected with multidrug-resistant organisms (i.e., Klebsiella  and Pseudomonas spp.).
• Importantly, aminoglycosides are concentration-dependent antibiotics and a greatly affected by the increased volume of distribution and altered elimination commonly seen in the critically ill.
• As a result, recommended doses are often too low to be effective. 
• Initial doses of aminoglycosides should, therefore, be higher in critically ill patients.
  • Amikacin: 25-30 mg/kg
  • Gentamicin: 7-9 mg/kg
  • Tobramycin: 7-9 mg/kg
• Subsequent doses are based on drug level monitoring.

References

Matthaiou DK, et al. What is new in the use of aminoglycosides in critically ill patients? Intensive Care Med 2014; 40:1553-1555.