An enzymatic, radiochemical assay procedure for measuring serum gentamicin by use of gentamicin 3-acetyl-transferase and [acetyl-14C]acetyl-Coenzyme A is described and evaluated. The enzyme stoichiometrically and quantitatively transfers a radioactive label to the analyte during a 10-min incubation at 37 degrees C. The labeled gentamicin is then absorbed onto phosphocellulose paper discs, which are washed to remove unreacted [acetyl-14C]-acetyl-Coenzyme A and counted in a liquid scintillation counter for 1 min each. The assay detects gentamicin in concentrations as low as 0.2 mg/liter and gives a linear response to concentrations as high as 20 mg/liter. Sisomicin, a structural analog of gentamicin, is measured by the procedure, and tobramycin and netilmicin are slightly reactive. No other interferents were found among other aminoglycosides, other antibiotics, or substances endogenous to serum. Results by the new method are compared to those by radioimmunoassay and a microbiological method.