HEALTHY LIFESTYLE




Gentamicin
Gentamicin.JPG

Gentamicin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

Once daily dose: 5–7 mg/kg, dose is then adjusted according to levelsEndocarditis: 1 mg/kg every 8 hours Intrathecal: 1–5 mg daily PD peritonitis: see local policy

PHARMACOKINETICS

  • Molecular weight                           :477.6
  • %Protein binding                           :0–30
  • %Excreted unchanged in urine     : 90
  • Volume of distribution (L/kg)       :0.3
  • half-life – normal/ESRD (hrs)      :2–3/20

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    30–70 3–5 mg/kg daily and monitor levels10–30 2–3 mg/kg daily and monitor levels5–10 2 mg/kg every 48–72 hours according to levels

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Dialysed.
  • CAPD                : clearance is about 3 mL/min. Dose as in GFR=5–10 mL/min. Monitor levels
  • HD                     :Dialysed. Dose as in GFR=5–10 mL/min. Give after dialysis
  • HDF/high flux   :Dialysed. Dose as in GFR=5–10 mL/min. Give after dialysis
  • CAV/VVHD      :Dialysed. Dose in GFR= 30–70 mL/min according to severity of infection, and measure levels

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsBotulinum toxin: neuromuscular block enhanced – risk of toxicity
  • Ciclosporin: increased risk of nephrotoxicityCytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds
  • Diuretics: increased risk of ototoxicity with loop diureticsMuscle relaxants: effects of non- depolarising muscle relaxants and suxamethonium enhancedParasympathomimetics: antagonism of effect of neostigmine and pyridostigmine
  • Tacrolimus: increased risk of nephrotoxicity

    ADMINISTRATION

    Reconstition

    Route

    IV, IM, IP, intrathecal

    Rate of Administration

    Bolus IV: over not less than 3 minutes Short infusion: 20–30 minutes Once daily large infusions over 30– 60 minutes

    Comments

    Can be added to sodium chloride or glucose 5%

    OTHER INFORMATION

    Concurrent penicillins may result in sub- therapeutic blood levelsMonitor blood levels. 1 hour post-dose peak levels must not exceed 10 mg/L. Pre-dose trough levels should be less than 2 mg/LIP therapy commonly used for PD peritonitis. Dose varies according to local protocol and whether
  • CAPD                : or APD dialysis. Monitoring of blood levels is advisable, as absorption is increased by inflamed peritoneumPotential nephrotoxicity of the drug may worsen residual renal functionLong-term concurrent use of gentamicin with teicoplanin causes additive ototoxicity.
  • other drugs