Gentamicin

In acute uncomplicated brucellosis, gentamicin belongs to the first-line doxycycline + gentamicin combination rather than acting as an optional add-on. In a 2024 network meta-analysis of randomized controlled trials (PLoS Neglected Tropical Diseases), doxycycline + gentamicin ranked first for efficacy and safety (SUCRA 0.94), ahead of the standard doxycycline + rifampicin. Earlier meta-analyses of randomized controlled trials (BMJ 2008, PLoS One 2012) showed that aminoglycoside-containing regimens produce fewer relapses and treatment failures. Gentamicin strengthens the bactericidal activity of doxycycline against intracellular Brucella.

ICD-10: A23 · ICD-11: 1B95

Gentamicin is a first-line agent for empirical treatment of early-onset neonatal sepsis, but only as the mandatory second drug alongside a beta-lactam: NICE NG195 (2021) names benzylpenicillin with gentamicin as the first-choice regimen, and the AAP (2018) recommends ampicillin with an aminoglycoside. The combination covers the main pathogens (group B streptococcus, Escherichia coli, and Listeria), with gentamicin adding synergy against the beta-lactam's targets. Gentamicin here is co-first-line rather than reserve, and is given once daily (Cochrane, Rao 2016). Cochrane systematic reviews (2021, 2016) support this regimen and the choice of combination.

ICD-10: P36 · ICD-11: KA60

In endocarditis caused by Enterococcus faecalis without high-level aminoglycoside resistance (non-HLAR), gentamicin is first-line: ampicillin plus gentamicin carries a Class I recommendation in the ESC 2023 and AHA/IDSA 2015 guidelines, on par with ampicillin plus ceftriaxone. Gentamicin is given at 3 mg/kg/day in 2–3 divided doses for a synergistic bactericidal effect with the beta-lactam, since beta-lactam therapy alone is only bacteriostatic against enterococci. Ampicillin plus ceftriaxone is an equivalent alternative when there is a risk of nephrotoxicity (Fernandez-Hidalgo, 2013), and this does not lower gentamicin's first-line status for non-HLAR strains. In staphylococcal endocarditis gentamicin plays a different role and is not first-line, so this entry should not be merged with broad gram-positive endocarditis.

ICD-10: I33 · ICD-11: BB40

In severe PID treated in hospital, intravenous gentamicin is part of one of the recommended parenteral regimens, combined with clindamycin, where the aminoglycoside adds Gram-negative coverage and complements anaerobic activity. In the CDC STI Treatment Guidelines, 2021, this regimen stands alongside the cephalosporin-based regimens with no reserve designation. The 2017 Cochrane systematic review found clindamycin plus an aminoglycoside non-inferior to cephalosporins and quinolones for cure rates. Once the patient improves clinically, parenteral therapy is switched to oral treatment.

ICD-10: N73 · ICD-11: GA05.Z

Gentamicin is a first-line agent for plague alongside streptomycin: aminoglycosides are recommended as primary parenteral therapy by the CDC (MMWR, 2021) and WHO (2021) guidelines. Treatment starts immediately when plague is suspected, without waiting for confirmation. In U.S. case series, aminoglycoside monotherapy showed survival of about 84% (systematic review, Clinical Infectious Diseases, 2020). In pregnancy, gentamicin is the preferred aminoglycoside.

ICD-10: A20 · ICD-11: 1B93

In severe tularemia, gentamicin is the preferred first-line aminoglycoside. The most recent CDC guidance (MMWR 2025) names it the drug of choice and advises starting with an aminoglycoside in severe disease, moving streptomycin to third line. A 2024 systematic review reports mortality on aminoglycoside therapy of about 0.7%. In pregnancy, gentamicin is preferred over streptomycin. Treatment is parenteral with monitoring of kidney function.

ICD-10: A21 · ICD-11: 1B94

Gentamicin is used for complicated UTI and acute pyelonephritis requiring parenteral therapy as an alternative to third-generation cephalosporins and fluoroquinolones. Advantages include activity against Pseudomonas and ESBL producers in some regions. IDSA 2010 includes aminoglycosides in complicated UTI regimens in groups at risk of resistance. After clinical response within 48–72 hours, switch to an oral agent guided by susceptibility.

ICD-10: N10 · ICD-11: GB51

Gentamicin is included in empirical regimens for suspected gram-negative bacteremia or sepsis in combination with a broad-spectrum beta-lactam. Surviving Sepsis Campaign 2021 recommends dual gram-negative coverage on day 1 in unstable patients and where multidrug-resistant pathogens are likely. After susceptibility data and patient stabilization, therapy is de-escalated. Once-daily dosing (5–7 mg/kg) is preferred for efficacy and safety, supported by the 2014 Cochrane review.

ICD-10: A41.5 · ICD-11: 1G40

In gram-positive infective endocarditis (staphylococcal, streptococcal), gentamicin is not the backbone but a short synergistic add-on to a beta-lactam or vancomycin in selected situations, such as the early phase of prosthetic-valve disease. The 2023 ESC guidelines cut back routine gentamicin because of nephrotoxicity: in most regimens it does not improve outcomes and is not recommended. The backbone is a beta-lactam or vancomycin, with gentamicin kept as a reserve component under renal-function monitoring. For Enterococcus faecalis endocarditis the role differs, where ampicillin plus gentamicin is part of first-line therapy.

Peak and trough levels are monitored: trough below 1 mcg/mL. In patients with renal impairment or ventilator-associated infection, dose and interval are adjusted to eGFR.

ICD-10: I33.0 · ICD-11: BB40