Names and pronunciation
jen-ta-mye′sin Cidomycin , Garamycin , Geratec , Gentrasul
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Individual generic drug information
Extracted information for gentamicin only.
jen-ta-mye′sin Cidomycin , Garamycin , Geratec , Gentrasul
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Func. class.: Antiinfective
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Chem. class.: Aminoglycoside
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Do not confuse: gentamicin/kanamycin
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ACTION: Interferes with protein syn- thesis in bacterial cell by binding to 30S ribosomal subunit, thus causing mis- reading of genetic code; inaccurate pep- tide sequence forms in protein chain, thereby causing bacterial death
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USES: Severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by susceptible strains of Pseudomonas aeruginosa, Proteus, Klebsiella, Serratia, Esche- richia coli, Enterobacter, Citrobacter, Staphylococcus, Shigella, Salmonella, Acinetobacter, Bacillus anthracis
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Extracted information for gentamicin only.
CONTRAINDICATIONS: Hyper- sensitivity to this product, other aminoglycosides Precautions: Breastfeeding, neonates, geriatric patients, pseudomembranous colitis, sulfite hypersensitivity
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Black Box Warning: Myasthenia gravis, Parkinson’s disease, infant botulism, tinni- tus, nephrotoxicity, neurotoxicity, pregnancy Black Box Warning: Increase: oto- toxicity, neurotoxicity, nephrotoxicity— other aminoglycosides, amphotericin B, polymyxin, vancomycin, ethacrynic acid, furosemide, mannitol, methoxyflurane, CISplatin, cephalosporins, penicillins, ci- dofovir, acyclovir, foscarnet, cycloSPORINE, tacrolimus, ganciclovir, zoledronic acid, pamidronate, monitor hearing Increase: effects—nondepolarizing neu- romuscular blockers, digoxin, entecavir, reduce dose or do not use together Drug/Lab Test Increase: LDH, AST, ALT, bilirubin, BUN, creatinine, eosinophils Decrease: Hb, WBC, platelets, serum cal- cium/sodium/potassium/magnesium Black Box Warning: Neurotoxicity: (my- asthenia gravis, Parkinson’s disease, infant botulism): monitor for paresthesias, tetany, positive Chvostek’s/Trousseau’s signs, confusion (adults), muscle weak- ness (infants); correct electrolyte imbal- ance • Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on actual body weight Black Box Warning: Nephrotoxicity: Monitor I&O ratio, urinalysis daily for pro- teinuria, cells, casts; report sudden change in urine output; urine pH if product is used for UTI; urine should be kept alkaline; urine for CCr testing, BUN, serum creatinine; lower dosage should be given with renal impairment (CCr <80 mL/min); toxicity is increased in patients with decreased renal function if high doses are given • VS during infusion; watch for hypoten- sion, change in pulse • IV site for thrombophlebitis, including pain, redness, swelling q30min, change site if needed; discontinue, apply warm compresses to site Black Box Warning: Peak/trough lev- els: Serum peak drawn at 30-60 min after IV infusion or 60 min after IM inj and trough level drawn just before next dose; blood level should be 2-4 times bacteriostatic level; peak (8 mcg/mL), trough (1-2 mcg/mL), depending on type of infection (based on traditional dosing), prolonged peak levels >10 mcg/mL may lead to toxicity Black Box Warning: Ototoxicity: As- sess eighth cranial nerve dysfunction by audiometric testing; also ringing, roaring in ears, vertigo; assess hearing before, during, after treatment • Dehydration: Monitor for high specific gravity, decrease in skin turgor, dry mu- cous membranes, dark urine • Superinfection: fever, malaise, red- ness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough or sputum • C&S before starting treatment to iden- tify infecting organism • Vestibular dysfunction: nausea, vomit- ing, dizziness, headache; product should be discontinued if severe • Inj sites for redness, swelling, ab- scesses; use warm compresses at site • Adequate fluids of 2-3 L/day unless con- traindicated to prevent irritation of tubules Black Box Warning: Pregnancy/ breastfeeding: identify whether preg- nancy is planned or suspected; do not use in pregnancy or breastfeeding, deaf- ness may occur in neonates Black Box Warning: Ototoxicity: to re- port loss of hearing; ringing, roaring in ears; feeling of fullness in head • To drink adequate fluids • To avoid hazardous activities until re- action is known
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SIDE EFFECTS CNS: Confusion, depression, numbness, tremors, seizures, muscle twitching, neurotoxicity, dizziness, vertigo, enceph- alopathy, fever, headache, lethargy CV: Hypo/hypertension, palpitations, edema EENT: Ototoxicity, deafness, visual dis- turbances, tinnitus GI: Nausea, vomiting, anorexia; increased ALT, AST, bilirubin; hepato- megaly, hepatic necrosis, splenomegaly GU: Oliguria, hematuria, renal damage, azotemia, renal failure, nephrotoxicity, proteinuria HEMA: Agranulocytosis, thrombocytope- nia, leukopenia, eosinophilia, anemia INTEG: Rash, burning, urticaria, dermati- tis, alopecia, photosensitivity, anaphylaxis MS: Twitching, myasthenia gravis–like symptoms RESP: Apnea
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INTERACTIONS • Do not use at the same time as or physically mix with penicillins, may inac- tivate gentamicin
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Extracted information for gentamicin only.
DOSAGE AND ROUTES Severe systemic infections • Adult: IV INFUSION 3-5 mg/kg/day in divided doses q8hr; IM 3-5 mg/kg/day in divided doses q8hr • Child: IM/IV 2-2.5 mg/kg q8hr • Neonate and infant: IM/IV 2.5 mg/kg q8-12hr • Neonate <1 wk: IM/IV 2.5 mg/kg q12hr Renal dose: regular dosing • Adult: IM/IV CCr 70-100 mL/min, re- duce dose by multiplying maintenance dose by 0.85, give q8-12hr; CCr 50-69 mL/min, reduce as above, give q12hr; CCr 25-49 mL/min, reduce as above, give q24hr; CCr <25 mL/min, reduce as above, give based on serum concentra- tions, give doses after dialysis
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Available forms: Inj 10, 40 mg/mL; premixed inj 70, 80, 100, 120, 160, 200/100 mL NS
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Administer: • Obtain C&S before starting treatment, treatment may be started before results are received • Draw for peak 1 hr after IM, 30 min after IV; draw trough before next dose, do not use heparin-coated tube for blood draw IM route • IM inj in large muscle mass; rotate inj sites • Product in evenly spaced doses to maintain blood level Intermittent IV INFUSION route • After diluting in 50-200 mL NS, D5W; decrease vol of diluent in child; maintain 0.1% sol run over 1⁄2-1 hr (adults) or up to 2 hr (children); flush IV line with NS, D5W after administration Y-site compatibilities: Alatrofloxacin, aldesleukin, alemtuzumab, alfentanil, alprostadil, amifostine, amikacin, amino- caproic acid, aminophylline, amioda- rone, amsacrine, anidulafungin, argatro- ban, arsenic trioxide, ascorbic acid injection, asparaginase, atenolol, atracu- rium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, carboplatin, carmus- tine, caspofungin, cefamandole, ceFAZolin, cefepime, cefotaxime, cefOXi- tin, cefpirome, ceftaroline, cefTAZidime, ceftizoxime, ceftRIAXone, cefuroxime, chlorothiazide, chlorpheniramine, chlor- proMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clarithromycin, clindamycin, cloxacillin, codeine, colisti- methate, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOru- bicin citrate liposome, DAUNOrubicin hydrochloride, dexmedetomidine, dexra- zoxane, digoxin, diltiazem, dimenhyDRI- NATE, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin hydrochloride, doxorubi- cin hydrochloride liposomal, doxycy- cline, edetate calcium disodium, edetate disodium, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ergonovine, ertapenem, erythromycin lactobionate, esmolol, eto- poside, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, gal- lamine, gallium, gatifloxacin, gem- citabine, glycopyrrolate, granisetron, HYDROmorphone, hydrOXYzine, ifos- famide, imipenem-cilastatin, irinotecan, isoproterenol, ketamine, ketorolac, labetalol, lactated Ringer’s injection, lan- soprazole, lepirudin, leucovorin, levo- floxacin, lidocaine, lincomycin, linezolid, LORazepam, magnesium sulfate, manni- tol, mechlorethamine, melphalan, meperidine, mephentermine sulfate, meropenem, mesna, metaraminol, meth- yldopate, methylPREDNISolone sodium succinate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbu- phine, nalorphine, naloxone, netilmicin, niCARdipine, nitroglycerin, nitroprus- side, norepinephrine, octreotide, ondan- setron, oritavancin, oxaliplatin, oxytocin, PACLitaxel (solvent/surfactant), palono- setron, pamidronate, pancuronium, papaverine, penicillin G potassium/ sodium, pentazocine, perphenazine, G PHENobarbital, phentolamine, phenyl- ephrine, phytonadione, piperacillin, polymyxin B, posaconazole, potassium acetate/chloride, procainamide, pro- chlorperazine, promazine, prometha- zine, propranolol, protamine, pyridoxine, quiNIDine gluconate, ranitidine, remifen- tanil, Ringer’s injection, riTUXimab, rocuronium, sargramostim, sodium ace- tate/bicarbonate/citrate, streptomycin, succinylcholine, SUFentanil, tacrolimus, telavancin, temocillin, teniposide, the- ophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofi- ban, TNA (3-in-1), tobramycin, tolazo- line, topotecan, TPN (2-in-1), trastu- zumab, trimetaphan, tubocurarine, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vin- CRIStine, vinorelbine, vitamin B complex with C, voriconazole, zidovudine, zole- dronic acid
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Extracted information for gentamicin only.
Assess:
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Evaluate: • Therapeutic response: absence of fever, draining wounds, negative C&S after treatment
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report headache, dizziness, symp- toms of overgrowth of infection, renal impairment
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Extracted information for gentamicin only.
PHARMACOKINETICS Not metabolized, excreted unchanged in urine, crosses placental barrier IM: Onset rapid, peak 30-60 min IV: Onset immediate; peak 30-90 min; plasma half-life 1-2 hr, infants 6-7 hr; duration 6-8 hr
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Filter the extracted dose blocks for this individual drug.
Severe systemic infections
• Neonate and infant: IM/IV 2.5 mg/kg q8-12hr
Candidate age grouping · source page 622