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HelpMayo Test ID GENPA Gentamicin, Peak, Serum
Specimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Serum gel tubes should be centrifuged within 2 hours of collection.
2. Red-top tubes should be centrifuged, and the serum aliquoted into a plastic vial within 2 hours of collection.
Useful For
Monitoring adequacy of drug clearance during gentamicin therapy
Method Name
Turbidimetric Immunoassay
Reporting Name
Gentamicin, Peak, SSpecimen Type
SerumSpecimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 7 days | |
| Frozen | 14 days | ||
| Ambient | 72 hours |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Gentamicin is an antibiotic used to treat life-threatening blood infections caused by gram-negative bacilli, particularly Citrobacter freundii, Acinetobacter species, Enterobacter species, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Providencia stuartii, Pseudomonas aeruginosa, and Serratia species. It is often used in combination with beta-lactam therapy.
A gentamicin minimal inhibitory concentration (MIC) of less than or equal to 4 mcg/mL is considered susceptible for gram-negative bacilli. A MIC of less than or equal to 500 mcg/mL is considered synergistic when combined with appropriate antibiotics for treatment of serious enterococcal infections.
Conventional dosing of gentamicin is usually given 2 to 3 times per day by intravenous or intramuscular injections in doses to achieve peak blood concentration between 3.0 and 12.0 mcg/mL depending on the type of infections. Gentamicin also may be administered at higher doses (usually 5-7 mg/kg) once per day to patients with good renal function (known as pulse dosing). Dosing amount or interval must be decreased to accommodate for reduced renal function.
Ototoxicity and nephrotoxicity are the primary toxicities associated with gentamicin. This risk is enhanced in presence of other ototoxic or nephrotoxic drugs. Monitoring of serum levels and symptoms consistent with ototoxicity is important. For longer durations of use, audiology/vestibular testing should be considered at baseline and periodically during therapy.
Reference Values
Peak: 3.0-12.0 mcg/mL
Toxic peak: >12.0 mcg/mL
Interpretation
Goal levels depend on the type of infection being treated. Peak targets are generally between 5.0 and 8.0 mcg/mL for less severe infections and 8.0 and 10.0 mcg/mL for severe infections. Prolonged exposure to peak levels exceeding 12.0 mcg/mL may lead to toxicity.
Cautions
Patient samples that contain the drug sisomicin will yield falsely elevated values for gentamicin. However, this drug is not usually coadministered with gentamicin.
High concentrations of penicillins or cephalosporins have been shown to inactivate gentamicin in vitro. The degree of inactivation is dependent on the particular aminoglycoside being measured, the type and concentration of the penicillin or cephalosporin that is also present, and the storage conditions of the sample. For patients receiving additional antibiotics of these types, 5 to 7 samples should be assayed immediately or stored frozen.
In very rare cases, patient samples may contain heterophile antibodies, which may produce low results with the QMS Gentamicin assay.
Interfering heterophile antibodies occur at low frequency in the general population. These antibodies can cause autoagglutination of the microparticle reagent leading to undetected erroneously low results.
Clinical Reference
1. Hammett-Stabler CA, Johns T: Laboratory guidelines for monitoring of antimicrobial drugs. Clin Chem 1998;44(5):1129-1140
2. Moyer TP: Therapeutic drug monitoring. In Tietz Textbook of Clinical Chemistry, Fourth edition. Edited by CA Burtis, ER Ashwood, Philadelphia, WB Saunders Company, 2006
3. Wilson JW, Estes LL: Mayo Clinic Antimicrobial Therapy Quick Guide. Mayo Clinic Scientific Press and Informa Healthcare USA, 2008
Method Description
The assay is a homogeneous particle-enhanced turbidimetric immunoassay. The assay is based on competition between drug in the sample and drug coated onto a microparticle for antibody binding sites of the gentamicin antibody reagent. The gentamicin-coated microparticle reagent is rapidly agglutinated in the presence of the antigentamicin antibody reagent and in the absence of any competing drug in the sample. The rate of absorbance change is measured photometrically. When a sample containing gentamicin is added, the agglutination reaction is partially inhibited, slowing down the rate of absorbance change. A concentration-dependent classic agglutination inhibition curve can be obtained with maximum rate of agglutination at the lowest gentamicin concentration and the lowest agglutination rate at the highest gentamicin concentration.(Package insert: Roche Gentamicin reagent, Roche Diagnostic Corp, Indianapolis, IN 01/2018)
Day(s) Performed
Monday through Sunday
Report Available
Same day/1 daySpecimen Retention Time
1 weekPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
80170
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| GENPA | Gentamicin, Peak, S | 3663-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| GENPA | Gentamicin, Peak, S | 3663-2 |