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Antibiotic Dosing in CKD

Gentamicin (Renal Dosing/TDM)

Brand names: Cidomycin

Gentamicin in the renal-dosing and therapeutic drug monitoring (TDM) context is an aminoglycoside antibiotic for serious Gram-negative infection; its narrow therapeutic index and renal elimination make dose individualisation and level monitoring essential, especially in CKD.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It binds the 30S bacterial ribosomal subunit to inhibit protein synthesis, producing concentration-dependent bactericidal activity against susceptible organisms.

Prescribing in practice

  • Nephrotoxicity and irreversible ototoxicity are the dominant risks, so dose by weight and renal function and use therapeutic drug monitoring to guide dosing and intervals.
  • Extend the dosing interval rather than simply cutting the dose in renal impairment, and check levels before deciding subsequent doses.
  • Avoid where possible in combination with other nephrotoxins or ototoxins, and review the need to continue daily.

Monitoring

Monitor renal function and gentamicin concentrations (peak and/or trough as per local protocol) to keep levels in the therapeutic range and pre-empt toxicity.

Counselling the patient

  • Blood tests to measure drug levels and kidney function are needed during treatment.
  • Report any hearing loss, ringing in the ears, dizziness or balance problems immediately.
  • Tell the team about all other medicines, as some increase the risk to kidneys and hearing.

Evidence & guidelines

UK antimicrobial guidance and NICE recommend weight- and renal-function-based aminoglycoside dosing with mandatory therapeutic drug monitoring.

Reference: Hartford Nomogram; NICE NG15 (Antimicrobial Stewardship); PHE Guidelines; SPC Cidomycin; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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