Antimicrobials

Aminoglycosides

Monitoring Aminoglycoside Induced Ototoxicity (Bayview Campus)

Is the patient awake and alert? 

Yes

Is patient likely to be treated with an aminoglycoside for >14 days? Or has patient received treatment with gentamicin, tobramycin, or amikacin during previous three months?

Yes »

At 8-10 days of cumulative aminoglycoside therapy, pharmacist will discuss with patient the signs and symptoms of ototoxicity and provide a patient information sheet containing their contact information. After counselling patient, pharmacist will record the following documentation in the History and Progress notes of medical record:

  • Date
  • Pharamacy Note:
  • Patient has been counseled about aminoglycoside therapy and provided with a patient information sheet, as per MAC approved ototoxicity protocol.
  • Pharmacist's Signature (Print name and include pager number)

After 13-15 days of cumulative aminoglycoside therapy, if treatment is to continue, pharmacist will write the following in the Doctor's Orders Section of the medical record:

As per MAC approved policy, Pharmacy Suggests: Patient has received --- days of aminoglycoside therapy. Auditory and vestibular testing to be done as follows:

  • STAT baseline audiogram*
  • STAT baseline ENG# (if patient is transportable)
  • MD to document in patient's medical record progress notes if patient is not transportable
  • Please co-sign order if approved
  • MD to inform ENT clinic of these orders at telephone extension x4138
  • Pharmacist's signature (Print name and include pager number)

Repeat audiogram and ENG to be done any time signs of ototoxicity become apparent. In addition, ENT will schedule repeat tests 14-21 days after baseline tests, if indicated.

No »

Continue aminoglycoside therapy and monitor patient for voluntary reports of auditory or vestibular toxicity.
No

Is patient likely to be treated with an aminoglycoside for >14 days? Or has patient received treatment with gentamicin, tobramycin, or amikacin during previous three months?

Yes »

Consider antimicrobial options that would limit the cumulative duration of use of aminoglycosides to a maximum of 14 days.

No »

Continue aminoglycoside therapy, as indicated for the patient's infection.

* STAT audiograms will be performed by ENT at patient's bedside within 1-2 week days of the physician's order.

# ENG (Electronystagmogram) is a test of vestibular function and will be performed by ENT in the ENG lab within 1-2 week days of the physician's order.


Last updated: June 20, 2016