DRUG STUDY

MEDICATION

GENERIC NAME:
GENTAMICIN
BRAND NAME: GAMAMYCIN
DRUG CLASS: AMINOGLYCOSIDES
FREQUENCY/DOSAGE:

Adults 3 mg/kg IM or IV infusion daily in three divided doses every 8 hours. For Site-threatening infections, may give up to 5 mg/kg daily in
divided doses every 8 hours; reduce dosage to 3 mg/kg daily as soon as patient improves. Children: 2 to 2.5 mg/kg IM or IV infusion every 8
hours. Neonates older than 1 week and infants: 2.5 mg/kg IM or IV infusion every 8 hours. Neonates younger than 1 week and preterm infants:
2.5 mg/kg IM or IV infusion every 12 hours. Adjust-a-dose: For adults with impaired renal function, dosages and frequency are determined by
drug level and renal function. Refer to manufacturer's instructions for renal function dosage adjustments. To maintain therapeutic levels, adults
should receive 1 to 1.7 mg/kg IM or IV infusion after each dialysis session, and children should receive 2 to 2.5 mg/kg IM or IV infusion after each
dialysis session.

ROUTE:

IV: Obtain specimen for culture and sensitivity tests before giving, Begin therapy while awaiting results. For intermittent infusion, dilute with 50
to 200 mL of D, W or NSS for injection. Infuse over 30 minutes to 2 hours. After completing infusion, flush the line with NSS or DW Premixed,
single-dose, flexible containers should be administered IV only. Incompatibilities: Don't physically pre- mix gentamicin with other drugs,
administer separately according to the recommended route of administration and dosage schedule.

IM: • Obtain specimen for culture and sensitivity tests before giving. Begin therapy while awaiting results. • Obtain blood for peak level 1 hour
after IM injection or 30 minutes after IV infusion finishes; for trough levels, draw blood just be- fore next dose. Don't collect blood in a
heparinized tube; heparin is incompatible with aminoglycosides.

INTERACTIONS Drug-drug. Black Box Warning Amikacin, carboplatin, cephaloridine, cidofovir, cisplatin, colistin, neomycin, paramycin, polymyxin
B, streptomycin, tobramycin, vancomycin, viomycin, other aminoglycosides: May increase ototoxicity and nephrotoxicity. Monitor hearing and
renal function test resuits. Avoid concurrent or sequennal use. Avcurium pancuranium, rocuranium, vecurs nium. May increase effects of
nondepolarizing muscle relaxants, including prolonged respiratory depression. Use together only when necessary, and expect to reduce dosage
of nondepolarizing muscle relaxant Bisphosphonate derivatives: May enhance hypocalcemic effect of bisphosphonate derivatives. Monitor
therapy. General anesthetics: May increase neuromuscular blockade. Monitor patient closely. Indomethacin. May increase peak and trough
levels of gentamicin. Monitor gentamicin level.

CONTRADICTIONS: Contraindicated in patients hypersensitive to drug or other aminoglycosides. • Use cautiously in neonates, infants, elderly
patients, and patients with impaired renal function or neuromuscular disorders. • Use drug for short-term treatment if possible. Prolonged use
may result in fungal or bacterial superinfection including CDAD. Dialyzable drug: 50%.

INDICATION: Serious infections caused by sensitive strains of Pseudomonas aeruginosa, Escherichia coli, Proteus, Klebsiella, Enterobacter,
Serratia, Citrobacter, or Staphylococcus.

MECHANISM OF ACTION: passes through the gram-negative membrane in an oxygen-dependent active transport. As oxygen is required, this is
why aminoglycosides are not effective in anaerobic bacteria. Gentamicin, like all aminoglycosides, exhibit concentration-dependent killing.

ADVERSE REACTIONS CNS: encephalopathy, seizures, fever, headache, lethargy, confusion, dizziness, numbness, depression, peripheral
neuropathy, vertigo, ataxia, tingling. CV: hypotension. EENT: ototoxicity, blurred vision, tinnitus. Gl: vomiting, nausea, weight loss. GU:
nephrotoxicity, possible increase in urinary excretion of casts. Hematologic: agranulocytosis, leukopenia, thrombocytopenia, anemia,
eosinophilia. Musculoskeletal: muscle twitching, myasthenia gravis-like syndrome. Respiratory: apnea. Skin: rash, urticaria, pruritus, injection-
site pain. Other: anaphylaxis.

SIDES EFFECT:

 Abdominal or stomach cramps or pain.

 agitation.

 back pain.

 black, tarry stools.

 blood in the urine.

 blurred or double vision.

 burning, numbness, tingling, or painful sensations.

 change in frequency of urination or amount of urine.

NURSING CONSIDERATION:
Evaluate patient's hearing before and during therapy. Notify pre- scriber if patient complains of tinnitus, vertigo, or hearing loss. Weigh patient
and review renal function studies before therapy begins. Alert: Use preservative-free form when intrathecal or intraventricular route is used
adjunctively for serious CNS infections, such as meningitis and ventriculitis. Maintain peak levels at 4 to 12 mcg/mL and trough levels at I to 2
mcg/ml. The maximum peak level is usually 8 mcg/mL, except in patients with cystic fibrosis, who need increased lung penetration. Prolonged
peak levels of 10 to 12 mcg/mL. or prolonged trough levels greater than 2 mcg/mL may increase risk of toxicity. Nephrotoxicity risk is greater in
patients with renal impairment and in those who receive high-dosage or pro- longed therapy. Monitor renal function: urine output, specific
gravity, urinalysis, BUN and creatinine levels, and CrCl. Report to pre- scriber evidence of declining renal function. High-risk patients should have
serial audiograms, especially if they show signs and symptoms of ototoxicity (dizziness, vertigo, ataxia, tinnitus, hearing loss). •Watch for signs
and symptoms of superinfection (especially of upper respiratory tract), such as continued fever, chills, and increased pulse rate. •Therapy usually
continues for 7 to 10 days. If no response occurs in 3 to 5 days, stop therapy and obtain new specimens for culture and sensitivity testing.

PATIENT TEACHING: • Instruct patient to promptly report adverse reactions, such as vision changes, dizziness, vertigo, unsteady gait, ringing in
the ears, hearing loss, numbness, tingling, muscle twitching, seizures, changes in urine amount, edema. • Encourage patient to drink plenty of
fluids. • Warn patient to avoid hazardous activities i adverse CNS reactions occur.