(jen ta mye' sin)
Alcomicin (CAN), Cidomycin (CAN), Garamycin, Pediatric Gentamicin Sulfate
Topical dermatologic cream, ointment:
Garamycin, Gentacidin, Gentak, Genoptic, Genoptic S.O.P.
Gentamicin impregnated PMMA beads:
Gentamicin Liposome injection:
Pregnancy Category D
Bactericidal: Inhibits protein synthesis in susceptible strains of gram-negative bacteria; appears to disrupt functional integrity of bacterial cell membrane, causing cell death.
· Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species, Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus species
· Serious infections when causative organisms are not known (often in conjunction with a penicillin or cephalosporin)
· Unlabeled use: With clindamycin as alternative regimen in PID
· Gram-negative infections
· Serious CNS infections, such as meningitis, ventriculitis, infections caused by susceptible Pseudomonas species
· Treatment of superficial ocular infections due to strains of microorganisms susceptible to gentamicin
Topical dermatologic preparation
· Infection prophylaxis in minor skin abrasions and treatment of superficial infections of the skin due to susceptible organisms amenable to local treatment
Gentamicin-impregnated PMAA beads on surgical wire
· Orphan drug use: Treatment of chronic osteomyelitis of posttraumatic, postoperative, or hematogenous origin
Gentamicin liposome injection
· Orphan drug use: Treatment of disseminated Myobacterium avium-intracellulare infection
Contraindications and cautions
· Contraindicated with allergy to any aminoglycosides.
· Use cautiously with renal or hepatic disease; preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; burn patients; lactation; pregnancy.
Injection—10, 40 mg/mL; ophthalmic solution—3 mg/mL; ophthalmic ointment—3 mg/g; topical ointment—0.1%; topical cream—0.1%; ointment—1 mg; cream—1 mg
3 mg/kg/day in three equal doses q 8 hr IM or IV. Up to 5 mg/kg/day in three to four equal doses in severe infections. For IV use, a loading dose of 1–2 mg/kg may be infused over 30–60 min, followed by a maintenance dose, usually for 7–10 days.
· PID: 2 mg/kg IV followed by 1.5 mg/kg tid plus clindamycin 600 mg IV qid. Continue for at least 4 days and at least 48 hr after patient improves, then continue clindamycin 450 mg orally qid for 10–14 days total therapy.
· Surgical prophylaxis regimens: Several complex, multidrug prophylaxis regimens are available for preoperative use; consult manufacturer's instructions.
2–2.5 mg/kg q 8 hr IM or IV.
Infants and neonates: 2.5 mg/kg q 8 hr.
Premature or full-term neonates: 2.5 mg/kg q 12 hr.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE
Reduce dosage or extend time dosage intervals, and carefully monitor serum drug levels and renal function tests.
ADULTS AND PEDIATRIC PATIENTS
1–2 drops into affected eye or eyes q 4 hr; use up to 2 drops hourly in severe infections.
ADULTS AND PEDIATRIC PATIENTS
Apply small amount to affected eye bid–tid.
ADULTS AND PEDIATRIC PATIENTS
Apply tid to qid. Cover with sterile bandage if needed.
Metabolism: Hepatic; T1/2: 2–3 hr
Distribution: Crosses placenta; enters breast milk
Preparation: Dilute single dose in 50–200 mL of sterile isotonic saline or D5W. Do not mix in solution with any other drugs.
Infusion: Infuse over 30–120 min.
Incompatibilities: Do not mix in solution with any other drugs.
· CNS: Ototoxicity—tinnitus, dizziness, vertigo, deafness (partially reversible to irreversible), vestibular paralysis, confusion, disorientation, depression, lethargy, nystagmus, visual disturbances, headache, numbness, tingling, tremor, paresthesias, muscle twitching, seizures, muscular weakness, neuromuscular blockade
· CV: Palpitations, hypotension, hypertension
· GI: Hepatic toxicity, nausea, vomiting, anorexia, weight loss, stomatitis, increased salivation
· GU: Nephrotoxicity
· Hematologic: Leukemoid reaction, agranulocytosis, granulocytosis, leukopenia, leukocytosis, thrombocytopenia, eosinophilia, pancytopenia, anemia, hemolytic anemia, increased or decreased reticulocyte count, electrolyte disturbances
· Hypersensitivity: Purpura, rash, urticaria, exfoliative dermatitis, itching
· Local: Pain, irritation, arachnoiditis at IM injection sites
· Other: Fever, apnea, splenomegaly, joint pain, superinfections
· Local: Transient irritation, burning, stinging, itching, angioneurotic edema, urticaria, vesicular and maculopapular dermatitis
Topical dermatologic preparations
· Local: Photosensitization, superinfections
· Increased ototoxic, nephrotoxic, neurotoxic effects with other aminoglycosides, cephalothin, potent diuretics, cephalosporins, vancomycin, methoxyflurane, enflurane
· Increased neuromuscular blockade and muscular paralysis with anesthetics, nondepolarizing neuromuscular blocking drugs, succinylcholine, citrate-anticoagulated blood
· Potential inactivation of both drugs if mixed with beta-lactam–type antibiotics (space doses with concomitant therapy)
· Increased bactericidal effect with penicillins, cephalosporins (to treat some gram-negative organisms and enterococci), carbenicillin, ticarcillin (to treat Pseudomonas infections)
· History: Allergy to any aminoglycosides; renal or hepatic disease; preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; lactation, pregnancy
· Physical: Site of infection; skin color, lesions; orientation, reflexes, eighth cranial nerve function; P, BP; R, adventitious sounds; bowel sounds, liver evaluation; urinalysis, BUN, serum creatinine, serum electrolytes, liver function tests, CBC
· Give by IM route if at all possible; give by deep IM injection.
· Culture infected area before therapy.
· Use 2 mg/mL intrathecal preparation without preservatives, for intrathecal use.
· Avoid long-term therapies because of increased risk of toxicities. Reduction in dose may be clinically indicated.
· Patients with edema or ascites may have lower peak concentrations due to expanded extracellular fluid volume.
· Cleanse area before application of dermatologic preparations.
· Ensure adequate hydration of patient before and during therapy.
· WARNING: Monitor renal function tests, CBCs, serum drug levels during long-term therapy. Consult with prescriber to adjust dosage.
· Apply ophthalmic preparations by tilting head back; place medications into conjunctival sac and close eye; apply light pressure on lacrimal sac for 1 min. Cleanse area before applying dermatologic preparations; area may be covered if necessary.
· You may experience these side effects: Ringing in the ears, headache, dizziness (reversible; use safety measures if severe); nausea, vomiting, loss of appetite (eat frequent small meals, perform frequent mouth care); burning, blurring of vision with ophthalmic preparations (avoid driving or performing dangerous activities if visual effects occur); photosensitization with dermatologic preparations (wear sunscreen and protective clothing).
· Report pain at injection site, severe headache, dizziness, loss of hearing, changes in urine pattern, difficulty breathing, rash or skin lesions; itching or irritation (ophthalmic preparations); worsening of the condition, rash, irritation (dermatologic preparation).
Adverse effects in Italic are most common; those in Bold are life-threatening.