Nursing Central: Antimicrobial Drugs—Aminoglycosides: Amikacin, Gentamicin, Tobramycin; Tricyclic Glycopeptide: Vancomycin

Antimicrobial Drugs—Aminoglycosides: Amikacin, Gentamicin, Tobramycin; Tricyclic Glycopeptide: Vancomycin

General

Synonym/Acronym:
Amikacin (Amikin); gentamicin (Garamycin, Genoptic, Gentacidin, Gentafair, Gentak, Gentamar, Gentrasul, G-myticin, Oco-Mycin, Spectro-Genta); tobramycin (Nebcin, Tobrex); vancomycin (Lyphocin, Vancocin, Vancoled).

Common Use:
To evaluate specific drugs for subtherapeutic, therapeutic, or toxic levels in treatment of infection.

Specimen:
Serum (1 mL) collected in a red-top tube.

Drug	Route of Administration	Recommended Collection Time*
Amikacin	IV, IM	Trough: immediately before next dose
		Peak: 30 min after the end of a 30-min IV infusion
Gentamicin	IV, IM	Trough: immediately before next dose
		Peak: 30 min after the end of a 30-min IV infusion
Tobramycin	IV, IM	Trough: immediately before next dose
		Peak: 30 min after the end of a 30-min IV infusion
Tricyclic glycopeptide and vancomycin	IV, PO	Trough: immediately before next dose Peak: 30–60 min after the end of a 60-min IV infusion
*Usually after fifth dose if given every 8 hr or third dose if given every 12 hr. IM = intramuscular; IV = intravenous; PO = by mouth.

Normal Findings:
(Method: Immunoassay)

Drug	Therapeutic Range*	SI Units	Half-Life (hr)	Distribution (L/kg)	Volume of Binding (%)	Protein Excretion
(SI = Conventional Units × 1.71)
Amikacin
Peak	15–30 mcg/mL	26–51 micromol/L	4–8	0.4–1.3	50	1° renal
Trough	4–8 mcg/mL	7–14 micromol/L
(SI = Conventional Units × 2.09)
Gentamicin (Standard dosing)
Peak	6–10 mcg/mL	12–21 micromol/L	4–8	0.4–1.3	50	1° renal
Trough	0.5–1.5 mcg/mL	1–3 micromol/L
(SI = Conventional Units × 2.09)
Tobramycin (Standard dosing)
Peak	4–8 mcg/mL	8.4–16.7 micromol/L	4–8	0.4–1.3	50	1° renal
Trough	Less than 1 mcg/mL	Less than 2.1 micromol/L
Tobramycin (Once daily dosing)
Peak	8–12 mcg/mL	16.7–25.1 micromol/L	4–8	0.4–1.3	50	1° renal
Trough	Less than 0.5 mcg/mL	Less than 1 micromol/L
(SI = Conventional Units × 0.69)
Vancomycin
Trough (General) Values vary with indication	10–15 mcg/mL	7–10.4 micromol/L
*Conventional units.

Antimicrobial Drugs—Aminoglycosides: Amikacin, Gentamicin, Tobramycin; Tricyclic Glycopeptide: Vancomycin has been found in Davis's Lab & Diagnostic Tests

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