The medical issues surrounding gentamicin administration and resulting ototoxicity and nephrotoxicity can be divided into 4 broad categories as set forth below. Links are provided to pages with a more in-depth analysis of each of these categories.

Appropriate Choice of Antibiotic. Although considered for decades to be a "big gun" in antibiotic therapy, newer anti-pseudomonal beta-lactame antibiotics have provided safer alternatives to gentamicin in most pseudomonal infections. Other superior alternative antibiotics exist for Staphylococcus aureus infections. Certain highly resistant infections might justify the judicious use of gentamicin as a primary antibiotic, at least for a short period of time. Emperic, short term use prior to obtaining definitive culture and sensitivity reports might also be justified.

Appropriate Dosing of Gentamicin Appropriate dosing requires adjusting the actual amount of gentamicin given per day to the patient's particular infectious process and to the patient's physiologic parameters. Dosing considerations in monotherapy or true combination therapy are different than when using gentamicin for synergistic effect.

Appropriate Monitoring of Gentamicin. Monitoring is an ongoing process of obtaining serum gentamicin levels, obtaining serum creatinine and Blood Urea Nitrogen (BUN) levels, and carefully observing the patient for physical symptoms of ototoxicity. The requirements for appropriate monitoring are dependent on the dose of gentamicin given per day, the duration of expected treatment, the patient's age, and the patient's pre-treatment and ongoing renal function.

Length of Treatment Issues. The length of time that a patient is exposed to gentamicin is a significant factor in developing nephrotoxicity and ototoxicity. While the traditional notion of antibiotic therapy ensuring complete eradication of the target organism is important, the toxic nature of gentamicin dictates that its course be kept to an absolute minimum