II. Indications
- Gram Negative Infections
III. Mechanism
- See Aminoglycoside
IV. Precautions
- Administer IV dose over 1 hour
- Adjust dosing per kinetics if >1-2 days use
- Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
V. Dosing: Adults and Children
- See Bacterial Conjunctivitis
- Adult
- Gentamicin 3 to 5 mg/kg/day divided every 8 hours IV or IM (FDA approved) OR
- Gentamicin 5 to 7 mg/kg/dose IV every 24 hours (off label)
- Child (age >1 month old, weight >2 kg)
- Gentamicin 2 to 2.5 mg/kg/dose IV or IM every 8 hours (FDA approved) OR
- Gentamicin 5 to 7 mg/kg/dose IV every 24 hours (off label)
-
Obesity
- Base dose on average between the Ideal Body Weight and actual weight
VI. Dosing: Infants
- See other references for preterm and Low Birth Weight Infants
- Term Infant (age <1 week, weight >2 kg)
- Gentamicin 2.5 mg/kg/dose IV or IM every 8 hours (FDA approved) OR
- Gentamicin 4 mg/kg IV every 24 hours (off-label)
- Term Infant (age 8 to 28 days, weight >2 kg)
- Gentamicin 2 to 2.5 mg/kg/dose IV or IM every 8 hours (FDA approved) OR
- Gentamicin 4 to 5 mg/kg IV every 24 hours (off-label)
VII. Dosing: Intravesical Gentamicin
- See Urinary Catheter associated Urinary Tract Infection (CAUTI)
- Indications (off label and uncommon use, but is used by urologists in some cases)
- Prophylaxis of recurrent Urinary Catheter associated Urinary Tract Infection (CAUTI)
- Treatment of CAUTI when systemic antibiotics carry greater risk (e.g. recurrent C. difficile)
- Compounding pharmacy
- Prepare Gentamicin 480 mg in 1 Liter Normal Saline (0.48 mg/ml)
- Divided into syringes each containing 50 ml solution (28.8 mg Gentamicin/syringe)
- Allows patient or their Caregiver to instill individual doses at home
- Instill into Bladder and plug or clamp catheter proximally
- Patient lies supine for 1 hour
- Drain Bladder after 1 hour
- Frequency and duration (varies considerably across studies and is not standardized)
- Treatment has been with irrigation twice daily for 7 days
- Prophylaxis of recurrent CAUTI
- Frequency varies from daily to 2-3 times weekly
- Duration varies from 2-3 weeks to 3 months, 9 months and 24 months
- References
VIII. Pharmacokinetics
- Target levels for multiple daily dosing
- Maintain Trough <2 mcg/ml
- Drawn immediately before next dose
- Maintain Peak at 5 to 8 mcg/ml in adults (4 to 6 mcg/ml for child)
- Draw 1 hour after Intramuscular dose
- Maintain Trough <2 mcg/ml
- Target levels for once daily dosing
- Maintain peak level 15 to 20 mcg/ml
- Maintain trough level <1 mcg/ml
- Indications for drug levels followed by Pharmacist
- See Aminoglycoside for Nephrotoxicity Risk factors
- Aminoglycoside use over 3 days
- Renal dysfunction
- Burn Injury
IX. Adverse Effects
- See Aminoglycoside
-
Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
- See Aminoglycoside for risk factors
X. Safety
- Pregnancy Category D
- Considered safe in Lactation
XI. Resources
- Gentamicin Injection Solution (DailyMed)
- Gentamicin Ophthalmic Solution (DailyMed)
- Gentamincin Ophthalmic Ointment (DailyMed)
Images: Related links to external sites (from Bing)
Related Studies
| gentamicin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| GENTAMICIN 0.1% CREAM | Generic | $1.07 per gram |
| GENTAMICIN 0.1% OINTMENT | Generic | $1.22 per gram |
| GENTAMICIN 0.3% EYE DROP | Generic | $0.72 per ml |