Gentamicin is an aminoglycoside antibiotic widely used to treat gram-negative bacillary infections. Because it has a low therapeutic index, monitoring of serum levels may help to insure adequacy of dosage and avoid toxicity. Microbiological assays are relatively slow and can be complicated by the presence of other antimicrobials. Radioimmunoassay (RIA) and acetylating radio-enzymatic assay (ARA) are new methods for gentamicin assay which offer the following advantages: rapidity (less than 3 hours); no interference by other antibiotics; RIA is extremely sensitive and ARA is versatile (being useful in the measurement of other aminoglycosides). Correlation coefficients determined by linear regression analysis of assays on 36 patient samples performed in duplicate on 2 different days demonstrated no significant difference in measurement of gentamicin by each of the methods. Factors such as numbers of specimens, cost, and time involved will affect the decision of the method to be applied in individual laboratories.