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Gelmetti first conducted an orchestra in Siena at age 16.
He has served as principal conductor of the Stuttgart Radio Symphony Orchestra (1989-1998) and of the Monte-Carlo Philharmonic Orchestra (1990-1991). Gelmetti became chief conductor of the Teatro dell'Opera di Roma in 2001 and held the post until 2008.
Gelmetti premiered Lorenzo Ferrero's opera Marilyn at the Teatro dell'Opera di Roma in 1980, Hans Werner Henze's Seventh Symphony with the Berlin Philharmonic Orchestra in 1984, and Sergio Rendine's Hermes 594 with the BBC Symphony Orchestra in 1987.
He made his first guest-conducting appearance with the Sydney Symphony Orchestra in 1994. He became chief conductor and artistic director of the orchestra in 2004, staying until the end of 2008. He has participated in conducting courses and masterclasses for young Australian conductors.
In March 2012, the Monte-Carlo Philharmonic Orchestra and its president, Princess Caroline of Monaco, announced the return of Gelmetti to the orchestra as chef référent to provide interim artistic leadership for the orchestra following the March 2011 death of the orchestra's prior principal conductor, Yakov Kreizberg. In January 2013, the orchestra formalised the full re-appointment of Gelmetti as its artistic director and music director. He concluded his second Monte Carlo tenure after the 2015-2016 season and now has the title of honorary conductor (Chef Honoraire) of the orchestra.
Gelmetti's compositions include Algos (for orchestra), Prasanta Atma (in memory of Sergiu Celibidache), Cantata della vita, and In Paradisum Deducant Te Angeli. In addition, he has taught at the Accademia Musicale Chigiana of Siena since 1997.
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