GENTAMICIN

Indications & Dose:

Gram-positive bacterial endocarditis or HACEK endocarditis (in combination with other antibacterials) 

BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION 

Adult: 1 mg/kg every 12 hours, intravenous injection to be administered over at least 3 minutes, to be given in a multiple daily dose regimen

Septicaemia Meningitis and other CNS infections Biliarytract infection Acute pyelonephritis Endocarditis Pneumonia in hospital patients | Adjunct in listerial meningitis | Prostatitis 

• BY INTRAVENOUS INFUSION, OR BY SLOW INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR INJECTION 

Adult: 3–5 mg/kg daily in 3 divided doses, to be given in a multiple daily dose regimen, divided doses to be given every 8 hours, intravenous injection to be administered over at least 3 minutes

• BY INTRAVENOUS INFUSION 

Adult: Initially 5–7 mg/kg, subsequent doses adjusted according to serum-gentamicin concentration, to be given in a once daily dose regimen CNS infections (administered on expert advice)

• BY INTRATHECAL INJECTION 

Adult: 1 mg daily, increased if necessary to 5 mg daily, seek specialist advice

Surgical prophylaxis

• BY SLOW INTRAVENOUS INJECTION

Adult: 1.5 mg/kg, intravenous injection to be administered over at least 3 minutes, administer dose up to 30 minutes before the procedure, dose may be repeated every 8 hours for high-risk procedures; up to 3 further doses may be given Surgical prophylaxis (including joint replacement surgery)

• BY INTRAVENOUS INFUSION 

Adult: 5 mg/kg for 1 dose, administer dose up to 30 minutes before the procedure

Children

3mg/kg/12 hourly upto two weeks, 2mg/kg eight hourly both i.m/i.v for 7-10 days

Endocarditis prophylaxis.

NOTE one hour (peak) concentration should not exceed 10mg/kg pre dose (trough) concentration should be less than 2mg/litre.

Neonates

up to 2 weeks 3mg/kg every 12 hour

* By intrathecal injection , seek specialist advice , 1mg daily (increased if necessary to 5mg daily).

Contraindications:

Preganancy & breast-feeding. Myasthenia gravis

Side Effects:

Ototoxicity (incidence is related to dose and duration of therapy), nephrotoxicity, hypersensitivity reactions, skin itching, headache, neuromuscular junction blockade, anorexia, nausea, vomiting, superinfection, photo-sensitivity, drowsiness, weakness, thrombocytopenia, agranulocytosis

Cautions:

Renal impairment, infants and elderly (adjust dose and monitor renal  auditory and vestibular function together with plasma Gentamycin concentration) avoid prolonged use 

Precautions:

Gentamicin dose is to be given on body weight basis and according to renal function.

Old age: May be used. 

Interaction:

Drugs

Amphotericin B, Cisplatin, Cephalosporin, Vancomycin, methoxyflurane, Fursemide,

Bumetanide: Increased nephrotoxicity. Anesthetics, Neuromuscular blocking agents (Tubocurarine): risk of neuromuscular blockade and respiratory paralysis.

Penicillin, Cephalosporins, Carbenicillin,Ticarcillin: Exert antibiotic synergism, especially useful in Pseudomonas infections.

Loop diuretics: Concurrent use of these agents may increase the risk of respiratory paralysis and renal dysfunction. 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: