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<h3>Background and Importance</h3> In the context of the hospital’s accreditation process, we implemented therapeutic drug monitoring (TDM) as an integral part of clinical pharmaceutical care, with the aim of optimising pharmacotherapy and enhancing patient safety. The focus was placed on aminoglycoside antibiotics, particularly gentamicin, which is frequently administered across hospital wards. <h3>Aim and Objectives</h3> The aim was not only to establish a clinical pharmacy service, but also to evaluate the appropriateness of prescribed doses in relation to patients‘ body mass index (BMI) and renal function. In addition, the rate of acceptance of pharmacists’ recommendations was assessed as an indicator of the quality of the clinical pharmacy service. <h3>Material and Methods</h3> A retrospective observational study was conducted in a general hospital between September 2022 and August 2025. Pharmacists interpreted the results of drug level determinations provided by the clinical laboratory and subsequently prepared TDM reports, which were entered into the hospital information system. The TDM reports were generated using the MWPharm+ software. <h3>Results</h3> Among the 201 patients included, only 22% (n = 45) received optimal doses of gentamicin, while 77% (n = 156) received inappropriate doses – 37% (n = 75) subtherapeutic and 40% (n = 81) supratherapeutic. In patients with creatinine below 45 μmol/l (n = 42), overdose was prevalent, occurring in 76% (n = 32) of cases. Conversely, in patients with creatinine above 85 μmol/l (n = 84), underdosing was observed in 48% (n = 40). Only 21% (n = 16) of patients with normal renal function received appropriate doses of gentamicin. The highest number of inappropriate doses was found in obese patients with a BMI greater than 25 kg/m<sup>2</sup> (n = 107), of whom 52 (26%) received subtherapeutic and 55 (27%) supratherapeutic doses. The acceptance rate of clinical pharmaceutical interventions increased significantly during the study period from 20% at baseline to 95% at the end of the study. <h3>Conclusion and Relevance</h3> In terms of achieving optimal gentamicin dosing, obese patients and patients with renal impairment were identified as groups at highest risk of incorrect dosing. Overall, TDM has become an integral part of clinical practice in our hospital and is increasingly recognised as a valuable tool in optimising drug therapy. <h3>Conflict of Interest</h3> No conflict of interest