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Gentamicin Dosing CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseGentamicin Dosing CKDESENeph

A 60-year-old man with CKD G4 is prescribed Gentamicin for a serious infection. What dosing and monitoring approach is essential?

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Correct answer: E — Extended-interval (once-daily) dosing with measured GFR-adjusted initial dose, mandatory pre-dose (trough) level monitoring, and avoidance beyond 5-7 days where possible; Gentamicin is ototoxic and nephrotoxic in CKD

Aminoglycosides (Gentamicin, Amikacin) require careful use in CKD: extended-interval dosing (once daily, adjusted for GFR) provides effective killing while minimising toxicity. Pre-dose (trough) level monitoring is mandatory to avoid accumulation (target trough <1 mg/L for Gentamicin). Duration should be minimised (5-7 days where possible). Risk factors for nephrotoxicity include pre-existing CKD, volume depletion, concurrent nephrotoxins (Vancomycin, Furosemide), and prolonged courses. Ototoxicity may be irreversible.

Reference: BNF 2024 – Gentamicin; NICE – Aminoglycoside Prescribing