| HOW SUPPLIED | | | | methoxyflurane, vancomycin, other aminoglycosides: |
| Injection: 40 mg/ml (adult), 10 mg/ml (pediatric) | | | | increased ototoxicity and nephrotoxicity. Use together |
| I. V. infusion (premixed): 40 mg, 60 mg, 70 mg, 80 mg, | | | | cautiously. |
| 90 mg, 100 mg, 120 mg in normal saline solution | | | | Cephalosporins: increased nephrotoxicity. Use together |
| ACTION | | | | cautiously. Dimenhydrinate: may mask symptoms of |
| Inhibits protein synthesis by binding directly to the 30S | | | | ototoxicity. Use with caution. |
| ribosomal subunit. Usually bactericidal. | | | | General anesthetics, neuromuscular blockers: may |
| INDICATIONS & DOSAGE | | | | potentiate neuromuscular blockade. Monitor closely. |
| Serious infections due to sensitive strains of | | | | Indomethacin: may increase serum peak and trough |
| Pseudomonas aeruginosa, Escherichia coli, Proteus, | | | | levels of gentamicin. Serum gentamicin ]evels must be |
| Klebsiella, Serratia, Enterobacter, Citrobacter, or | | | | monitored closely. |
| Staphylococcus | | | | I. V. loop diuretics (such as furosemide): increased |
| Adults: 3 mg/kg daily in divided doses I.M. or I.V. infusion | | | | ototoxicity. Use cautiously. Parenteral penicillins (such as |
| q 8 hours. For life threatening infections, patient may | | | | ampicillin and ticarcillin): gentamicin inactivation in vitro. |
| receive up to 5 mg/kg daily in three to four divided | | | | Don't mix together. |
| doses; dose should be reduced to 3 mg/kg daily as | | | | EFFECTS ON DIAGNOSTIC TESTS |
| soon as clinically indicated. | | | | None reported. |
| Children: 2 to 2.5 mg/kg q 8 hours I.M. or by I. V. | | | | CONTRAINDICATIONS |
| infusion. | | | | Contraindicated in hypersensitivity to drug or other |
| Neonates over age 1 week or infants: 2.5 mg/kg q 8 | | | | aminoglycosides |
| hours I.M. or by I. V. infusion. | | | | SPECIAL CONSIDERATIONS |
| Neonates under age 1 week and pretenn infants: 2.5 | | | | • Use cautiously in neonates, infants, elderly patients, |
| mg/kg q 12 hours I.M. or by I.V. infusion. | | | | and patients with impaired renal function or |
| Meningitis - | | | | neuromuscular disorders. |
| Adults: systemic therapy as above. | | | | • A specimen for culture and sensitivity tests is |
| Children: systemic therapy as above. | | | | obtained before first dose is given. |
| Endocarditis prophylaxis for GI or GU procedure or | | | | • Patient's hearing must be evaluated before and |
| surgery- | | | | during therapy. Patient complaints of tinnitus, vertigo, or |
| Adults: 1.5 mg/kg LM. or LV. 30 minutes before | | | | hearing loss are important. |
| procedure or surgery. Maximum dose is 80 mg. Given | | | | • Patient's weight and renal function studies must be |
| with ampicillin (vancomycin in penicillinallergic patients). | | | | reviewed before therapy begins. |
| Children: 2 mg/kg LM. or I.V. 30 minutes before | | | | • Alert: Preservative-free formulations of gentamicin |
| procedure or surgery. Maximum dose is 80 mg. | | | | are used when the intrathecal route is ordered. |
| Given with ampicillin (vancomycin in penicillin allergic | | | | • Blood for peak gentamicin level is obtained I hour |
| patients). | | | | after I.M. injection or 30 minutes after LV. infusion |
| After hemodialysis to maintain therapeutic blood | | | | finishes; for trough levels, blood is drawn just before |
| levels - | | | | next dose. Blood must not be collected in a heparinized |
| Adults: 1 to 1.7 mg/kg I.M. or by LV. inusion after each | | | | tube; heparin is incompatible with aminoglycosides. |
| dialysis. | | | | • Peak blood levels over 10 mcg/ml and trough |
| Children: 2 to 2.5 mg/kg LM. or by 1. V. infusion after | | | | levels over 2 mcg/m] may be associated with higher |
| each dialysis. | | | | incidence of toxicity. |
| Dosage adjustment: For adult patients with impaired | | | | • Urine output, specific gravity, urina]ysis, BUN and |
| renal function, doses and frequency are determined by | | | | creatinine levels, and creatinine clearance must be |
| serum gentamicin levels and renal function. | | | | monitored. |
| ADVERSE REACTIONS | | | | • Hemodialysis for 8 hours removes up to 50% of |
| CNS: headache, lethargy, encephalopathy, confusion, | | | | drug from blood. |
| dizziness, seizures, numbness, peripheral neuropathy, | | | | • Superinfection (continued fever and other signs |
| vertigo, ataxia, tingling. | | | | and symptoms of new infection, especially of upper |
| CV: hypotension. | | | | respiratory tract) may occur. |
| EENT: ototoxicity, blurred vision, tinnitus. | | | | • Therapy usually continues for 7 to 10 days. If no |
| GI: vomiting, nausea. | | | | response occurs in 3 to 5 days, therapy may be |
| GU: nephrotoxicity; possible elevation in BUN, nonprotein | | | | stopped and new specimens obtained for culture and |
| nitrogen, or serum creatinine levels; possible increase | | | | sensitivity testing. |
| in urinary excretion of casts. | | | | I. V. administration |
| Hematologic: anemia, eosinophilia, leukopenia, | | | | • When giving by intermittent LV. infusion, the drug is |
| thrombocytopenia, agranulocytosis. | | | | diluted with 50 to 200 ml of Ds W or normal saline |
| Hepatic: increased ALT, AST, bilirubin, LD. | | | | injection and infused over 30 minutes to 2 hours. After |
| Musculoskeletal: muscle twitching, myasthenia | | | | completing LV. infusion, the line is flushed with normal |
| gravis-like syndrome. | | | | saline solution or Ds W. |
| Respiratory: apnea. | | | | Patient teathing |
| Skin: rash, urticaria, pruritus. | | | | • Maintain adequate fluid intake and report adverse |
| Other: fever, anaphylaxis; injection site pain. | | | | reactions promptly. |
| INTERACTIONS | | | | • Don't perform hazardous activities if adverse |
| Drug-drug. Acyclovir, amphotericin B, cisplatin, | | | | CNS reactions occur. |