Indications: septicaemia and neonatal sepsis; meningitis and other CNS infections; biliary-tract infection, acute pyelonephritis or prostatitis, endocarditis; pneumonia in hospital patients, adjunct in listerial meningitis.

Caution pregnancy; renal impairment, neonates, infants and elderly (adjust dose and monitor renal, auditory and vestibular function together with serum gentamicin concentrations); avoid prolonged use; conditions characterised by muscular weakness; obesity (use ideal weight for height to calculate dose and monitor serum- gentamicin concentration closely).

Contra-indications: myasthenia gravis.

Side Effects: vestibular and auditory damage, nephrotoxicity; rarely, hypomagnesaemia on prolonged therapy, antibiotic-associated colitis, stomatitis; nausea, vomiting, rash, blood disorders.

Dose: By intramuscular or by slow intravenous injection over at least 3 minutes or by intravenous infusion, 3–5 mg/kg daily (in divided doses every 8 hours);

NEONATE up to 2 weeks, 3 mg/kg every 12 hours; CHILD 2 weeks–12 years, 2 mg/kg every 8 hours.

Endocarditis (in combination with other antibacterial), ADULT 1 mg/kg every 8 hours

Endocarditis prophylaxis: Once daily dose regimen, by intravenous infusion, initially 5–7 mg/kg, then adjusted according to serum-gentamicin concentration.

By intrathecal injection, seek specialist advice, 1 mg daily (increased if necessary to 5 mg daily)

Pregnancy: Second and third trimester: Auditory or vestibular nerve damage; risk greatest with streptomycin; probably very small with gentamicin and tobramycin, but avoid unless essential.