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Gentamicin sulfate

Serious infections due to sensitive strains of Pseudomonas aeruginosa, Escherichia coli, Proteus, Klebsiella, Serratia, Entero­bacter, Citrobacter, or Staphylococcus­

Adults: 3 mg/kg daily in divided doses I.M. or I.V. infusion q 8 hours. For life threatening infections, patient may receive up to 5 mg/kg daily in three to four di­vided doses; dose should be reduced to 3 mg/kg daily as soon as clinically indicated.

HOW SUPPLIED

Injection: 40 mg/ml (adult), 10 mg/ml (pediatric)

I. V. infusion (premixed): 40 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 120 mg in normal saline solution

ACTION

Inhibits protein synthesis by binding directly to the 30S ribosomal subunit. Usually bactericidal.

INDICATIONS & DOSAGE

Children: 2 to 2.5 mg/kg q 8 hours I.M. or by I. V. infusion.

Neonates over age 1 week or infants: 2.5 mg/kg q 8 hours I.M. or by I. V. infusion.

Neonates under age 1 week and pretenn infants: 2.5 mg/kg q 12 hours I.M. or by I.V. infusion.

Meningitis -

Adults: systemic therapy as above.

Children: systemic therapy as above.

Endocarditis prophylaxis for GI or GU procedure or surgery-

Adults: 1.5 mg/kg LM. or LV. 30 minutes before procedure or surgery. Maximum dose is 80 mg. Given with ampicillin (vancomycin in penicillinallergic patients).

Children: 2 mg/kg LM. or I.V. 30 minutes before procedure or surgery. Maxi­mum dose is 80 mg. Given with ampicillin (vancomycin in penicillin allergic patients).

After hemodialysis to maintain thera­peutic blood levels -

Adults: 1 to 1.7 mg/kg I.M. or by LV. inusion after each dialysis.

Children: 2 to 2.5 mg/kg LM. or by 1. V. infusion after each dialysis.

Dosage adjustment: For adult patients with impaired renal function, doses and frequency are determined by serum gentamicin levels and renal function.

ADVERSE REACTIONS

CNS: headache, lethargy, encephalopathy, confusion, dizziness, seizures, numb­ness, peripheral neuropathy, vertigo, ataxia, tingling.

CV: hypotension.

EENT: ototoxicity, blurred vision, tinnitus.

GI: vomiting, nausea.

GU: nephrotoxicity; possible elevation in BUN, nonprotein nitrogen, or serum cre­atinine levels; possible increase in urinary excretion of casts.

Hematologic: anemia, eosinophilia, leukopenia, thrombocytopenia, agranulocytosis.

Hepatic: increased ALT, AST, bilirubin, LD.

Musculoskeletal: muscle twitching, myasthenia gravis-like syndrome.

Respiratory: apnea.

Skin: rash, urticaria, pruritus.

Other: fever, anaphylaxis; injection site pain.

INTERACTIONS

Drug-drug. Acyclovir, amphotericin B, cisplatin, methoxyflurane, vancomycin, other aminoglycosides: increased ototoxicity and nephrotoxicity. Use together cautiously.

Cephalosporins: increased nephrotoxicity. Use together cautiously. Dimenhydrinate: may mask symptoms of ototoxicity. Use with caution.

General anesthetics, neuromuscular blockers: may potentiate neuromuscular blockade. Monitor closely.

Indomethacin: may increase serum peak and trough levels of gentamicin. Serum gentamicin ]evels must be monitored closely.

I. V. loop diuretics (such as furosemide): increased ototoxicity. Use cautiously. Parenteral penicillins (such as ampicillin and ticarcillin): gentamicin inactivation in vitro. Don't mix together.

EFFECTS ON DIAGNOSTIC TESTS

None reported.

CONTRAINDICATIONS

Contraindicated in hypersensitivity to drug or other aminoglycosides

SPECIAL CONSIDERATIONS

" Use cautiously in neonates, infants, elderly patients, and patients with impaired renal function or neuromuscular disorders.

" A specimen for culture and sensitivity tests is obtained before first dose is given.

" Patient's hearing must be evaluated before and during therapy. Patient complaints of tinnitus, vertigo, or hearing loss are important.

" Patient's weight and renal function studies must be reviewed before therapy begins.

" Alert: Preservative-free formulations of gentamicin are used when the intrathecal route is ordered.

" Blood for peak gentamicin level is obtained I hour after I.M. injection or 30 minutes after LV. infusion finishes; for trough levels, blood is drawn just before next dose. Blood must not be collected in a heparinized tube; heparin is incompatible with aminoglycosides.

" Peak blood levels over 10 mcg/ml and trough levels over 2 mcg/m] may be associated with higher incidence of toxicity.

" Urine output, specific gravity, urina]y­sis, BUN and creatinine levels, and crea­tinine clearance must be monitored.

" Hemodialysis for 8 hours removes up to 50% of drug from blood.

" Superinfection (continued fever and other signs and symptoms of new infection, especially of upper respiratory tract) may occur.

" Therapy usually continues for 7 to 10 days. If no response occurs in 3 to 5 days, therapy may be stopped and new specimens obtained for culture and sensitivity testing.

I. V. administration

" When giving by intermittent LV. infusion, the drug is diluted with 50 to 200 ml of Ds W or normal saline injection and infused over 30 minutes to 2 hours. After completing LV. infusionFree Articles, the line is flushed with normal saline solution or Ds W.

Patient teathing

" Maintain adequate fluid intake and report adverse reactions promptly.

" Don't perform hazardous activities if adverse CNS reactions occur.

Source: Free Articles from ArticlesFactory.com

ABOUT THE AUTHOR


Michael Russell Facts and information on drugs and benefits on taking them. If you want, you may publish the above article on your site, but a link back (Direct Link, HTML Clickable Link) needs to be provided to authors site at: http://www.drug-facts.net/blog/.



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