Indications: serious gram-negative infections resistant to gentamicin.

Cautions: pregnancy, renal impairment, neonates and infants.

Contra-indications: myasthenia gravis.

Side Effects: vestibular and auditory damage; nephrotoxicity; colitis; nausea, vomiting and rash.

Pharmacokinetics: This is an aminoglycoside antibiotic. One-hour (‘peak’) serum concentration should not exceed 30 mg/litre; pre-dose (‘trough’) concentration should be less than 10 mg/litre.

Dose: by IM injection or slow IV injection or infusion, 15mg/kg daily in 2 divided doses, increased to 22.5 mg/kg daily in 3 divided doses in severe infections; max.

1.5 g daily for up to 10 days (max. cumulative dose 15 g); child 15 mg/kg daily in 2 divided doses; neonate loading dose of 10 mg/kg then 15 mg/kg daily in 2 divided doses.

Pregnancy: In second and third trimester: Auditory or vestibular nerve damage.