Aminoglycosides: an update on indications, dosing and monitoring

Aminoglycosides (gentamicin, tobramycin and amikacin) are highly effective parenteral drugs commonly used as initial empirical therapy of serious Gram-negative infections. They have rapid bactericidal activity and relatively low rates of resistance in Australia compared with other antibiotics used to manage Gram-negative infections. Therapeutic Guidelines: Antibiotic was updated in March 2025 and provides new guidance on the role of aminoglycosides, optimised dosing, and drug selection. The guidelines now recommend that dosing in adults is based on lean body weight, and provide calculators to assist with dose calculations. Therapeutic drug monitoring is required when aminoglycoside therapy is expected to continue beyond 48 hours; monitoring the area under the aminoglycoside concentration-time curve is recommended in adults.