Classes
DEA Class; Rx
Common Brand Names;
- Aminoglycosides
gentamicin topical (Rx)
- Classes: Antibacterials, Topical
gentamicin ophthalmic (Rx)
- Classes: Aminoglycosides, Ophthalmic
Description
Aminoglycoside antibiotic
Used for a variety of gram-negative bacterial infections as well as synergistically for gram-positive bacterial infections, such as endocarditis
Major toxicities include nephrotoxicity, ototoxicity, neurotoxicity; careful patient monitoring is suggested. Available in a variety of dosage forms to be used topically, via ophthalmic route, and as systemic parenteral therapy.
Indications
Indicated for Susceptible Infections
- In underweight and nonobese patients, use of total body weight (TBW) instead of ideal body weight for determining initial mg/kg/dose is accepted; ideal body weight (IBW) also may be used to determine doses for patients who are neither underweight nor obese
Indicated for Surgical Prophylaxis (Off-label)
Indicated for Infective Endocarditis Treatment, Cystic Fibrosis (Off-label), Pelvic Inflammatory Disease (Off-label), Plague (Yersinia pestis) Treatment (Off-label).
Indicated for Gram-Negative Infections, Conjunctivitis & Postoperative Prophylaxis
Contraindications
Prior aminoglycoside toxicity or hypersensitivity
Skin rash
Hypersensitivity to aminoglycosides or any component of product
Adverse Effects
- Neurotoxicity (vertigo, ataxia)
- Gait instability
- Ototoxicity (auditory, vestibular)
- Nephrotoxicity (decreased CrCl)
- Nephrotoxicity if trough >2 mg/L
- Allergic contact dermatitis
- Erythema
- Pruritus
- Contain other ingredients such as parabens which may also cause allergic contact dermatitis
- Transient irritation, burning, stinging
- Increased redness, lacrimation
Warnings
Patients treated withaminoglycosides should be under close clinical observation; high risk of toxicity associated with their use
Risk of ototoxicity; tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage; discontinue therapy if signs of ototoxicity occur
Risk of nephrotoxicity; other factors that increase patient risk of ototoxicity include advanced age and dehydration
Narrow therapeutic index (not intended for long-term therapy)
Caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission
Adjust dose in renal impairment
Endocarditis prophylaxis (GI, GU procedure): AHA Guidelines recommend only for high-risk patients
Diuretics may enhance aminoglycoside toxicity by altering antibiotic concentration in serum and tissue; certain diuretics by themselves may cause ototoxicity; avoid potent diuretics, including ethacrynic acid or furosemide
Use caution in patients with electrolyte abnormalitie including hypocalcemia, hypomagnesemia, or hypokelemia
Use caution in patients with neuromuscular disorders, including myasthenia gravis
Use caution in patients with hearing and renal impairment
Local redness/irritation reported
Not for long term therapy
Prolonged use of topical antibiotics may give rise to overgrowth of nonsusceptible organisms including fungi
Pregnancy and Lactation
Pregnancy category: D
Lactation: Enters breast milk; use with caution (AAP Committee states “compatible with nursing”)
Maximum Dosage
Aminoglycoside dosing is highly variable and dependent on several factors. 5 mg/kg/day IV/IM is FDA-approved maximum; however, doses of 7 mg/kg/day IV have been used in extended-interval dosing regimens. There is no maximum dose stated for ophthalmic or topical administration.
Aminoglycoside dosing is highly variable and dependent on several factors. 5 mg/kg/day IV/IM is FDA-approved maximum; however, doses of 7 mg/kg/day IV have been used in extended-interval dosing regimens. There is no maximum dose stated for ophthalmic or topical administration.
Aminoglycoside dosing is highly variable and dependent on several factors. 7.5 mg/kg/day IV/IM is FDA-approved maximum. There is no maximum dose stated for ophthalmic or topical administration.
Aminoglycoside dosing is highly variable and dependent on several factors. 7.5 mg/kg/day IV/IM is FDA-approved maximum. There is no maximum dose stated for ophthalmic or topical administration.
Aminoglycoside dosing is highly variable and dependent on several factors. 7.5 mg/kg/day IV/IM is FDA-approved maximum. There is no maximum dose stated for ophthalmic administration. Safety and efficacy of topical administration have not been established.
Aminoglycoside dosing is highly variable and dependent on several factors. 7.5 mg/kg/day IV/IM is FDA-approved maximum; however, this dose is not typically used in clinical practice. Usual maximum doses in neonates are as follows:
35 weeks gestation and older: 4 to 5 mg/kg/dose IV/IM every 24 hours.
30 to 34 weeks gestation: 5 mg/kg/dose IV/IM every 24 to 36 hours.
Younger than 30 weeks gestation: 5 mg/kg/dose IV/IM every 36 to 48 hours.
How supplied
Gentamicin sulfate