IV Gentamicin for adults - 48 hourly prescribing and other alternative dosing schedules
There is a risk that IV gentamicin prescribed 48 hourly may inadvertently be prescribed and/or administered 24 hours earlier than intended. This can lead to gentamicin toxicity, including serious renal impairment/oto-vestibular toxicity.
All nursing staff, medical staff and pharmacists should take action to minimise the risks of this happening.
Learning/good practice points:
All staff groups
- Remember that there are different gentamicin dosing regimens used in NHSGGC (treatment dose, synergistic dosing for endocarditis and surgical prophylaxis/catheter stat dose) which are prescribed, dosed and monitored differently. See further information below.
Medical staff
- Prescribe each dose of gentamicin on the date it is due - do NOT prescribe more than 24 hours in advance. Patients on gentamicin should be reviewed daily with an assessment of their clinical status (including for signs of toxicity and the need for ongoing IV antibiotics), renal function and gentamicin blood concentration results. In most cases the risks of prescribing gentamicin doses a day in advance outweigh any perceived benefits.
- If a patient’s dosing schedule is 48 hourly, then write the date and “no dose required – 48 hourly dosing” on the gentamicin prescribing, administration and monitoring (PAM) chart on the date(s) that NO gentamicin dose is due (see chart image below).
Nursing Staff
- Before preparing and administering IV gentamicin carefully check the date and time the dose is prescribed (see chart image below).
- Check the PRN medication on HEPMA on every medication round. If the patient is prescribed gentamicin (or vancomycin) PRN you must then check the paper prescribing, administration and monitoring (PAM) chart to see if a dose is due.
- Once a dose has been administered it must be documented on the PAM chart and on HEPMA, ensuring that the actual time of administration is recorded accurately on both.
Pharmacists
- Be alert to potential errors with 48 hourly and alternative gentamicin dosing schedules and highlight the risks/recommended correct practice to prescribers and nurses on your wards.
(if viewing image on a mobile device switch to landscape).
Further information
- Intravenous gentamicin and vancomycin for adults on HEPMA: Frequently Asked Questions
- GGC Medicines - - Gentamicin dosing guidelines (age 16 and over)
- Synergistic Gentamicin for Endocarditis in adults (426) (nhsggc.org.uk)
- Antibiotic Prophylaxis in Surgery/Procedures General Principles (Includes Gentamicin Dosing for Surgical Prophylaxis) (1039) (nhsggc.org.uk)
- Sample gentamicin prescribing, administration and monitoring (PAM) chart (on StaffNet, GGC network access required) here.
Please encourage the discussion of this information at local teaching sessions and team meetings.
Written by NHSGGC Antimicrobial Pharmacy Team in collaboration with Communications subcommittee of ADTC.
Published 07/10/2022. Medicines Update blogs are correct at the time of publication.