CautionGeneric
Gentamicin
Aminoglycoside
Critical adjunct in severe pelvic sepsis; ototoxic on the fetus.
IVIM
First-line for
- Severe puerperal/pelvic sepsis (with amox + metro)
- Pyelonephritis (with amox)
- Endocarditis prophylaxis (specific)
Mechanism
Binds 30S ribosome → irreversible misreading; bactericidal, concentration-dependent.
“5 mg/kg, once daily, level at 6–14 h”
- Use Hartford/extended-interval
- Renal function critical
- Audiogram pre-treat if >5 days
Dosing
- IV
- 5 mg/kg OD; trough <1 mg/L
Contraindications
- AbsoluteMyasthenia gravis
- CautionRenal impairment, vestibular disease
Side effects
- Nephrotoxicity (reversible)
- Ototoxicity — vestibular & cochlear, irreversible
- Neuromuscular block
Fetal & maternal notes
- • Crosses placenta — fetal 8th nerve toxicity reported with prolonged courses
- • Use short courses; avoid streptomycin/kanamycin
Key interactions
Furosemide
AvoidSynergistic ototoxicity
Mg sulfate
AvoidPotentiated NM block
Vancomycin
CautionAdditive nephrotoxicity
Clinical pearls
- 💡 Single doses for sepsis are pragmatically used in pregnancy — benefit > risk
- 💡 Never give if MG
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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