Gentamicin Dosing and Monitoring Challenges in End-Stage Renal Disease

Florczykowski B and Storer

Abstract

The second leading cause of mortality in end-stage renal disease patients on intermittent hemodialysis is infection. Gentamicin is frequently used in this patient population to treat infections due to the convenience of dosing only on hemodialysis days. Dosing recommendations vary among the most commonly used drug information databases. Differences are found in recommendations for both dosing and monitoring. Conflicting information found in drug information databases and primary literature can cause confusion among clinicians regarding the best way to dose and monitor gentamicin in ESRD patients on hemodialysis. While current practice utilizes posthemodialysis gentamicin dosing, there is primary literature that introduces the concept of pre-dialysis dosing. Predialysis gentamicin dosing may result in favorable pharmacokinetic profile.