Sample identification: Three patient identifiers from Name D. Address N. Gentamicin is an aminoglycoside antibiotic that is used primarily to treat serious infectious diseases caused by gram-negative bacilli. Gentamicin is an aminoglycoside antibiotic commonly used for the treatment of infections and surgical prophylaxis. It is not absorbed from the gut when administered orally, and is therefore predominantly administered via intramuscular or intravenous injection.
Gentamicin can cause serious dose-related side effects including nephrotoxicity and irreversible hearing loss, so it is important to ensure patients receive the correct dose and are monitored regularly. Aminoglycosides have bactericidal activity for some Gram-positive and most aerobic and facultative anaerobic Gram-negative bacteria.
They act by inhibiting protein synthesis. Once inside the bacterial cell, they bind to the 30S subunit of the ribosome causing misreading of mRNA, resultin g in interruption of normal bacterial protein synthesis [1]. As aminoglycoside uptake into bacteria is oxygen dependent, they are therefore not active against anaerobes.
Gentamicin is commonly used to treat urinary tract infections, sepsis, intra-abdominal infections, endocarditis, pelvic inflammatory disease and complicated skin, bone and soft tissue infections. It is often used for more serious Gram-negative infections, or in combination with a broad spectrum beta lactam antibiotic to provide coverage against Gram-positive bacteria.
Gram-negative bacteria can be difficult to treat because of the complex nature of their cell wall. Beta lactam antibiotics active against the cell wall e. Amino glycosides may cause auditory or vestibular nerve damage in infants if used during the second or third trimesters of pregnancy, and should be avoided if possible.
If treatment is required, gentamicin is the preferred aminoglycoside because, although it does cross the placenta, it has not been associat ed with developmental toxicity [4]. It can also be used in patients who are breastfeeding [5]. Gentamicin is contr aindicated in patients with myasthenia gravis, where neuromuscular transmission may be impaired.
It should also be avoided in patients taking drugs that can cause nephrotoxicity e. Gentamicin is usually given by slow bolus injection over two to three minutes or via intravenous infusion over 30 minutes.
Ideal body weight IBW should be used in all non-obese patients, unless actual body weight is lower; in these patients actual body weight should be used. Aminoglycosides are not distributed into adipose tissue, as they are highly hydrophilic. Gentamicin and other aminoglycosides are cleared by the kidneys, and it is therefore important that renal function is assessed before treatment starts.
For intrathecal or intraventricular injection, use preservative-free intrathecal preparations only. With intrathecal use in adults. For choice of antibacterial therapy, see Antibacterials, use for prophylaxis , Blood infections, antibacterial therapy , Cardiovascular system infections, antibacterial therapy , Central nervous system infections, antibacterial therapy , Eye infections, antibacterial therapy , Gastro-intestinal system infections, antibacterial therapy , Respiratory system infections, antibacterial therapy , Urinary-tract infections.
For choice of antibacterial therapy, see Diabetic foot infections, antibacterial therapy , Skin infections, antibacterial therapy. When used by eye. With intramuscular use or intrathecal use or intravenous use or intraventricular use in children. Other drugs classified as aminoglycosides. By slow intravenous injection For Adult 1.
Gentamicin doses in BNF publications may differ from those in product literature. When used by ear patent grommet although may be used by specialists, see Ear ; perforated tympanic membrane although may be used by specialists, see Ear. When used by ear avoid prolonged use. Route-specific information Since systemic absorption can follow topical application, the possibility of interactions with topical gentamicin should be borne in mind. The influence of haemodialysis and concomitant administration of carbenicillin further complicate dosage estimations in patients with renal insufficiency.
There are no reliable studies from which to derive a comparable value for trough pre-dose concentrations.
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