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To monitor the level of an aminoglycoside antibiotic such as gentamicin, tobramycin, or amikacin in the blood to ensure adequate dosing and help avoid toxic side effects
At regular intervals during treatment with an aminoglycoside
A blood sample drawn from a vein
No test preparation is needed, but the timing of the blood sample is important.
Follow your healthcare provider's directions for collection. It may be helpful to tell the laboratory professional drawing your blood the time your last dose was completed.
Aminoglycosides are a group of antibiotics that are used to treat serious bacterial infections. The level of the prescribed aminoglycoside in the blood is measured in order to adjust doses as necessary and ensure effective treatment while avoiding toxic side effects. (For more information about this, see the article on Therapeutic Drug Monitoring.)
Gentamicin, tobramycin, and amikacin are the most commonly prescribed aminoglycosides, and they are used to treat infections caused by certain types of Gram-negative bacteria as well as a few Gram-positive bacteria. (For more on these, see the article on the Gram stain).
It is important to monitor the concentration of aminoglycosides because their effectiveness depends on having an adequate level in the blood. Aminoglycosides are associated with serious toxic side effects, including damage to hearing and/or balance (ototoxicity) and acute kidney damage (nephrotoxicity). Though kidney damage caused by aminoglycosides is usually reversible, hearing and/or balance loss is frequently permanent. These side effects can occur at any time, but the risk is greater with elevated blood levels and when the drugs are given for an extended period of time. The risk of side effects is lower with some of the aminoglycosides that have been developed recently.
Aminoglycosides are not well absorbed by the digestive system, so they are typically be administered either through a needle into a vein (intravenously, IV) or by injection into a muscle (intramuscularly, IM). Aminoglycosides can be given:
The amount of an aminoglycoside given per dose depends on a variety of factors, including kidney function, other drugs you may be taking, your age and weight.
When a dose of aminoglycosides is given, the level typically rises in the blood to a peak concentration and then falls over time to a lower (trough) concentration. Sometimes these drugs are prescribed using interval dosing, in which the subsequent dose is timed to be given in anticipation of the falling level. The goal is to dose a sufficient amount of drug to maintain a therapeutic level that will kill the bacteria causing the infection. The dose and the dosing interval are optimized to give the body enough time to clear most of the drug from the previous dose before the next dose is given. This minimizes the risk of complications and helps ensure that an adequate drug level is always maintained in the blood.
Aminoglycosides are sometimes prescribed alone but are often combined with other antibiotics. Monitoring the antibiotic blood level is especially important in the presence of other medications, as they can affect the ability of the body to process (metabolize) and clear the drug.
This test is used to monitor the level of the prescribed aminoglycoside antibiotic in the blood. Testing is used to ensure that the level of the drug in the blood is sufficient to treat the infection but not so high as to increase the risk of side effects.
In some cases, a dose of the drug is given only once every 24-48 hours (called extended-interval or pulse dosing). A test of the drug level on a sample taken 6-14 hours after the dose is used to ensure adequate dosing.
Blood drug levels are used by clinical pharmacists and healthcare providers to calculate the rate at which your body clears the drug from your blood. These results are then used to determine the appropriate amount of drug and the appropriate timing between doses to assure that the blood concentration is adequate for treating the infection but is not so high as to increase the risk of toxic side effects. For additional information on how the test is used, see Therapeutic Drug Monitoring.
Blood levels of gentamicin, tobramycin or amikacin may be monitored under a variety of conditions. For example, your age, kidney function, overall health, and presence of underlying conditions or symptoms of toxicity may be considered in the decision to perform the testing. The length of treatment and type of protocol used for dosing can also be factors.
Monitoring of aminoglycosides may be recommended when you will be receiving the drug for more than 3 days.
More frequent aminoglycoside monitoring may be performed for people with impaired kidney function (renal insufficiency) and for people who have an increased risk of toxic side effects, such as those taking other drugs known to adversely affect hearing and the kidneys (ototoxic or nephrotoxic).
For an extended-dose regimen, the results can help your healthcare provider decide when to give the next dose. In general, if the blood level is at the low end of the range, the healthcare practitioner may decide to dose every 24 hours. If the level is at the higher end (indicating that the drug is being cleared more slowly), the healthcare practitioner may wait 48 hours before giving the next dose.
If your infection is not responding to the treatment, then your healthcare provider may either continue the drug for a longer period of time or consider other treatment options.
Intravenous doses of aminoglycosides are given slowly over about 30 minutes.
Other forms of aminoglycosides, such as eye drops, ear drops, and inhaled drugs, may be used to treat specific types of infections. Monitoring is not used in these cases.
The first aminoglycoside, streptomycin, was developed in the 1940s and used successfully to treat tuberculosis. Its use declined with the introduction of other aminoglycosides.
Aminoglycosides are cleared from the body by the kidneys, thus dosages are modified based upon kidney function. Tests that reflect the health of the kidneys, such as a creatinine and estimated glomerular filtration rate (eGFR), are often ordered prior to the initiation of aminoglycoside therapy and then at intervals to monitor kidney function.
Risk of toxicity is increased in people who are taking other drugs that affect hearing and the kidneys such as certain diuretics, particularly furosemide, or NSAIDS (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen, or other antibiotics such as vancomycin.
Because of the potential for complications, extended-interval dosing is not recommended in people who:
Although you may receive intravenous aminoglycoside therapy at home, usually administered by a home health professional, blood levels cannot be monitored at home. The test requires specialized equipment and must be performed in a laboratory. The home health professional may draw a blood sample prior to administering the next dose of drug. This sample will be sent to a laboratory for analysis.
There are risks and benefits associated with almost all drug therapies. Aminoglycosides continue to be very effective at killing Gram-negative bacteria and sometimes these drugs are the best alternative for successfully treating serious infections.
No, not all antibiotics require monitoring. Unlike aminoglycosides, most antibiotics are not associated with significant side effects that are predictable with drug levels. They have a larger therapeutic range in which they are effective. Because of this, they can be prescribed based upon pre-established dosing schedules.
Sources Used in Current Review
2020 review performed by Wendy S. Shea, MT(ASCP), Atrium Health, Carolinas Medical and the Editorial Review Board.
Werth, B. Aminoglycosides. Merck Manual, professional version. Available online at https://www.merckmanuals.com/professional/infectious-diseases/bacteria-and-antibacterial-drugs/aminoglycosides. Accessed March 2020.
Germovsek E, Barker CI, Sharland M. What do I need to know about aminoglycoside antibiotics? Archives of Disease in Childhood - Education and Practice 2017;102:89-93. Available at https://www.ncbi.nlm.nih.gov/pubmed/27506599. Accessed March 2020.
Block M, Blanchard DL. Aminoglycosides. [Updated 2019 Oct 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available online at https://www.ncbi.nlm.nih.gov/books/NBK541105/. Accessed March 2020.
Krause KM, Serio AW, Kane TR, Connolly LE. Aminoglycosides: An Overview. Cold Spring Harb Perspect Med. 2016;6(6):a027029. Published 2016 Jun 1. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888811/. Accessed March 2020.
(November 16, 2018) Serio A, et al. Aminoglycoside Revival: Review of a Historically Important Class of Antimicrobials Undergoing Rejuvenation. Available online at https://www.asmscience.org/content/journal/ecosalplus/10.1128/ecosalplus.ESP-0002-2018. Accessed March 2020.
Fosso Yatchang, Marina & Li, Yijia & Garneau-Tsodikova, Sylvie. (2014). New trends in aminoglycosides use. Med. Chem. Commun. 5. 10.1039/C4MD00163J. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111210/. Accessed March 2020.
Sources Used in Previous Reviews
Billings, K. (Updated 2012 April 6). Ototopical Antibiotics. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/873963-overview. Accessed September 2012.
Devabhakthuni, S. (Updated 2011 May). Antibiotic Pharmacokinetic Monitoring. American Society of Health-System Pharmacists [On-line information]. Available online at http://www.ashp.org/DocLibrary/MemberCenter/NPF/2011Pearls/Antibiotic-Pharmacokinetic-Monitoring.aspx. Accessed September 2012.
Dugdale, D. (Updated 2011 September 20). Acute tubular necrosis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000512.htm. Accessed September 2012.
(© 2012). Causes of Dizziness. Vestibular Disorders Association [On-line information]. Available online at http://vestibular.org/node/2. Accessed September 2012.
(Reviewed 2010 May). Aminoglycoside Extended Interval Dosing and Monitoring in Adults. New York-Presbyterian Hospital Guideline: Medication Use Manual [On-line information]. Available online through http://www.cumc.columbia.edu. Accessed September 2012.
(© 1984-2012). Section 2 Aminoglycosides. RxKinetics Pharmacokinetic Concepts [On-line information]. Available online at http://www.rxkinetics.com/pktutorial/2_3.html. Accessed September 2012.
Moulds, R. and Jeyasingham, M. (2010 October). Gentamicin: a great way to start. Aust Prescr v 33 (5) 134–5. [On-line information]. Available online at http://www.australianprescriber.com/magazine/33/5/134/5. Accessed September 2012.
(© 2002). Ototoxicity. Vestibular Disorders Association [On-line information]. Available online at http://vestibular.org/ototoxicity. Accessed September 2012.
Mudd, P. (2012 May 7). Ototoxicity. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/857679-overview#showall. Accessed September 2012.
Lerma, E. et. al. (2011 March 29). Pathophysiologic Mechanisms of Selected Types of Nephrotoxicity. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/1925868-overview. Accessed September 2012.
Gonzalez, U. and Spencer, J. (1998 November 15). Aminoglycosides: A Practical Review. Am Fam Physician. v58 (8):1811-1820. [On-line information]. Available online at http://www.aafp.org/afp/1998/1115/p1811.html. Accessed September 2012.
Levison, M. (Revised 2009 July). Aminoglycosides. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed September 2012.
Jasmin, L. (Updated 2011 October 30). Vertigo-associated disorders. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001432.htm. Accessed September 2012.
Tan, K. et. al. (2003 March 15). Aminoglycoside Prescribing and Surveillance in Cystic Fibrosis. Am. J. Respir. Crit. Care Med v167 (6) 819-823 [On-line information]. Available online at http://ajrccm.atsjournals.org/content/167/6/819.full. Accessed September 2012.
Levison, M. (Revised 2008 September). Antibiotics. Merck Manual Home Health Handbook [On-line information]. Available online at http://www.merckmanuals.com/home/print/infections/antibiotics/antibiotics.html. Accessed September 2012.
(2011 April 18). Extended Interval Aminoglycoside Monitoring and Dosing Guideline (Gentamicin/Tobramycin ONLY). Alberta Health Services, Covenant Health, Regional Laboratory Services [On-line information]. Available online through http://www.albertahealthservices.ca. Accessed September 2012.
Hammett-Stabler, C. and Johns, T. (1998 May). Laboratory guidelines for monitoring of antimicrobial drugs. Clinical Chemistry May 1998 v 44 (5) 1129-1140. [On-line information]. Available online at http://www.clinchem.org/content/44/5/1129.full. Accessed September 2012.
Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 581.
(June 18, 2012) UCSF Infectious Disease Management Program, Guidelines for Antimicrobial Dosing in Adults, Aminoglycosides. Available online at http://clinicalpharmacy.ucsf.edu/idmp/adult_guide/aminoglycoside_dosing.htm. Accessed October 2012.
Article reviewed May 2015 by Jennifer M. Colby, PhD, DABCC.
(March 6, 2014). Drew, R.H. Dosing and administration of parenteral aminoglycosides. UpToDate. Available online at http://www.uptodate.com/contents/dosing-and-administration-of-parenteral-aminoglycosides. Accessed on 5/6/15.
(July 16, 2014). Drew, R.H. Aminoglycosides. UpToDate. Available online at http://www.uptodate.com/contents/aminoglycosides. Accessed on 5/6/15.
Wong, G. et al. How do we use therapeutic drug monitoring to improve outcomes from severe infections in critically ill patients? BMC Infectious Diseases. 2014 14:288.
Banerjee, S., Narayanan, M., and Gould K. Monitoring aminoglycoside level. BMJ. 2012 345:e6354.
Roberts, J.A. et al. Individualized antibiotic dosing for patients who are critically ill: challenges and potential solutions. The Lancet. 2014. 14:498-509.
Clarke, W. Editor. Contemporary Practice in Clinical Chemistry. 2nd Edition, AACC Press, Washington DC.
(©2013) UCSF Infectious Disease Management Program. Guidelines for Antimicrobial Dosing in Adults, Aminoglycosides. Available online at http://idmp.ucsf.edu/aminoglycoside-dosing-and-monitoring-recommendations. Accessed May 2015.