منتدى الأدوية الطبية
Bactericidal: Inhibits protein synthesis in susceptible strains of gram-negative bacteria; appears to disrupt functional integrity of bacterial cell membrane, causing cell death.
· Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species, Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus species
· Serious infections when causative organisms are not known (often in conjunction with a penicillin or cephalosporin)
· Unlabeled use: With clindamycin as alternative regimen in PID
· Gram-negative infections
· Serious CNS infections, such as meningitis, ventriculitis, infections caused by susceptible Pseudomonas species
· Treatment of superficial ocular infections due to strains of microorganisms susceptible to gentamicin
Topical dermatologic preparation
· Infection prophylaxis in minor skin abrasions and treatment of superficial infections of the skin due to susceptible organisms amenable to local treatment
Gentamicin-impregnated PMAA beads on surgical wire
· Orphan drug use: Treatment of chronic osteomyelitis of posttraumatic, postoperative, or hematogenous origin
Gentamicin liposome injection
· Orphan drug use: Treatment of disseminated Myobacterium avium-intracellulare infection
Contraindications and cautions
· Contraindicated with allergy to any aminoglycosides.
· Use cautiously with renal or hepatic disease; preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; burn patients; lactation; pregnancy.
Metabolism: Hepatic; T1/2: 2–3 hr
Distribution: Crosses placenta; enters breast milk
Preparation: Dilute single dose in 50–200 mL of sterile isotonic saline or D5W. Do not mix in solution with any other drugs.
Infusion: Infuse over 30–120 min.
Incompatibilities: Do not mix in solution with any other drugs.
· CNS: Ototoxicity—tinnitus, dizziness, vertigo, deafness (partially reversible to irreversible), vestibular paralysis, confusion, disorientation, depression, lethargy, nystagmus, visual disturbances, headache, numbness, tingling, tremor, paresthesias, muscle twitching, seizures, muscular weakness, neuromuscular blockade
· CV: Palpitations, hypotension, hypertension
· GI: Hepatic toxicity, nausea, vomiting, anorexia, weight loss, stomatitis, increased salivation
· GU: Nephrotoxicity
· Hematologic: Leukemoid reaction, agranulocytosis, granulocytosis, leukopenia, leukocytosis, thrombocytopenia, eosinophilia, pancytopenia, anemia, hemolytic anemia, increased or decreased reticulocyte count, electrolyte disturbances
· Hypersensitivity: Purpura, rash, urticaria, exfoliative dermatitis, itching
· Local: Pain, irritation, arachnoiditis at IM injection sites
· Other: Fever, apnea, splenomegaly, joint pain, superinfections
· Local: Transient irritation, burning, stinging, itching, angioneurotic edema, urticaria, vesicular and maculopapular dermatitis
Topical dermatologic preparations
· Local: Photosensitization, superinfections
· Increased ototoxic, nephrotoxic, neurotoxic effects with other aminoglycosides, cephalothin, potent diuretics, cephalosporins, vancomycin, methoxyflurane, enflurane
· Increased neuromuscular blockade and muscular paralysis with anesthetics, nondepolarizing neuromuscular blocking drugs, succinylcholine, citrate-anticoagulated blood
· Potential inactivation of both drugs if mixed with beta-lactam–type antibiotics (space doses with concomitant therapy)
· Increased bactericidal effect with penicillins, cephalosporins (to treat some gram-negative organisms and enterococci), carbenicillin, ticarcillin (to treat Pseudomonas infections)
· History: Allergy to any aminoglycosides; renal or hepatic disease; preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; lactation, pregnancy
· Physical: Site of infection; skin color, lesions; orientation, reflexes, eighth cranial nerve function; P, BP; R, adventitious sounds; bowel sounds, liver evaluation; urinalysis, BUN, serum creatinine, serum electrolytes, liver function tests, CBC
· Give by IM route if at all possible; give by deep IM injection.
· Culture infected area before therapy.
· Use 2 mg/mL intrathecal preparation without preservatives, for intrathecal use.
· Avoid long-term therapies because of increased risk of toxicities. Reduction in dose may be clinically indicated.
· Patients with edema or ascites may have lower peak concentrations due to expanded extracellular fluid volume.
· Cleanse area before application of dermatologic preparations.
· Ensure adequate hydration of patient before and during therapy.
· WARNING: Monitor renal function tests, CBCs, serum drug levels during long-term therapy. Consult with prescriber to adjust dosage.
· Apply ophthalmic preparations by tilting head back; place medications into conjunctival sac and close eye; apply light pressure on lacrimal sac for 1 min. Cleanse area before applying dermatologic preparations; area may be covered if necessary.
· You may experience these side effects: Ringing in the ears, headache, dizziness (reversible; use safety measures if severe); nausea, vomiting, loss of appetite (eat frequent small meals, perform frequent mouth care); burning, blurring of vision with ophthalmic preparations (avoid driving or performing dangerous activities if visual effects occur); photosensitization with dermatologic preparations (wear sunscreen and protective clothing).
· Report pain at injection site, severe headache, dizziness, loss of hearing, changes in urine pattern, difficulty breathing, rash or skin lesions; itching or irritation (ophthalmic preparations); worsening of the condition, rash, irritation (dermatologic preparation(
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