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Antimicrobial Stewardship — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipAntimicrobial StewardshipSCE Infectious Diseases

A clinical pharmacist queries whether an antibiotic prescription of IV Gentamicin requires therapeutic drug monitoring. The Gentamicin is prescribed as a once-daily (extended-interval) regimen for Gram-negative sepsis. What is the correct TDM approach?

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Correct answer: D — Measure a trough level (pre-dose, at 18–24 hours); target trough <1 mg/L

For once-daily (extended-interval) Gentamicin, TDM focuses on trough levels taken pre-dose (typically at 18–24 hours after the dose). The target trough is <1 mg/L to minimise nephrotoxicity and ototoxicity. Peak levels are not routinely measured in once-daily regimens as the high Cmax is intentional for concentration-dependent killing. The Hartford nomogram or local protocols guide dose adjustments. Renal function should be monitored daily.

Reference: BNF 2024 – Gentamicin; BSAC 2023 – Aminoglycoside TDM guidelines