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.
