II. Pharmacokinetics

  1. Maintain Trough <2 ug/ml
    1. Drawn immediately before next dose
  2. Maintain Peak at 5-8 ug/ml (4-6 ug/ml for child)
    1. Draw 1 hour after Intramuscular dose
  3. Indications for pharmacokinetics followed by PharmD
    1. Aminoglycoside use over 3 days
    2. Renal dysfunction

III. Precautions

  1. Administer IV dose over 1 hour
  2. Adjust dosing per kinetics if >1-2 days use
  3. Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)

IV. Dosing: Infants

  1. Term Infant
    1. Gentamycin 2.5 mg/kg/dose IV or IM q8 hours
  2. Preterm Infant
    1. Gestational age >34 weeks and Weight over 2000 grams
      1. Gentamycin 2.5 mg/kg/dose IV or IM q12 hours
    2. Gestational age <34 weeks
      1. Weight over 1250 grams
        1. Gentamycin 2.5 mg/kg/dose IV or IM q18 hours
      2. Weight Under 1250 grams
        1. Gentamycin 2.5 mg/kg/dose IV or IM q24 hours
    3. Age >7 days
      1. Gentamycin 2.5 mg/kg/dose IV or IM q12 hours
  3. Renal Impairment Adjustments
    1. Serum Creatinine 0.7 to 1.1
      1. Gentamycin 2.5 mg/kg/dose IV or IM q24 hours
    2. Serum Creatinine 1.1 to 1.3
      1. Gentamycin 2.5 mg/kg/dose IV or IM q36 hours
    3. Serum Creatinine > 1.3
      1. Gentamycin 2.5 mg/kg/dose IV or IM q48 hours

V. Dosing: Children and adults

  1. Child
    1. Gentamicin 2 to 2.5 mg/kg IV or IM q8 hours
    2. Gentamicin 4.5 mg/kg IV q24 hours
  2. Adults
    1. Gentamicin 1-1.5 mg/kg IV or IM q8 hours or
    2. Gentamicin 5-7 mg/kg IV q24 hours

VI. Risk Factors for Nephrotoxicity

  1. Advanced age
  2. Prior Renal Insufficiency
  3. Dehydration
  4. Hypokalemia
  5. Hypomagnesemia
  6. Liver disease
  7. Sepsis
  8. Drug Interactions with other nephrotoxic medications
    1. Cephalothin (Keflin) and other Cephalosporins
    2. Cyclosporin A
    3. Cisplatin
    4. NSAIDS
    5. ACE Inhibitors
    6. Methoxyflurane
    7. Loop Diuretics
    8. Amino acids

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Cost: Medications

Gentamicin (on 6/18/2017 at Walmart.com)
Gentamicin 0.3% op. soln (5ml) #1 bottle for $4.00 $4.00 each
Gentamicin 0.3% op. soln (5ml) #3 bottles for $10.00 $3.33 each
gentamicin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GENTAMICIN 0.1% CREAM Generic $2.14 per gram
GENTAMICIN 0.1% OINTMENT Generic $2.05 per gram
GENTAMICIN 0.3% EYE DROPS Generic $1.05 per ml
GENTAMICIN 0.3% EYE OINTMENT Generic $3.81 per gram
GENTAMICIN 3 MG/ML EYE DROPS Generic $1.05 per ml
GENTAMICIN 80 MG/2 ML VIAL Generic $0.52 per ml

Ontology: Antibiotics, Aminoglycoside (C0003233)

Definition (NCI) Any antibiotic containing amino-modified sugars originally isolated from various Streptomyces and Micromonospora species. Aminoglycoside antibiotics bind to the 16S RNA of the bacterial 30S ribosomal subunit, inhibiting translation and protein synthesis. Aminoglycoside use is associated with ototoxicity, neurotxicity and nephrotoxicity.
Definition (NCI_NCI-GLOSS) A family of antibiotics that works against many types of bacteria and includes streptomycin, gentamicin, and neomycin. Aminoglycosides are used to treat bacterial infections.
Definition (CSP) any of a group of antibiotics derived from various species of Streptomyces or produced synthetically; they inhibit protein synthesis by binding with the 30S ribosomal subunit.
Concepts Antibiotic (T195) , Carbohydrate (T118)
SnomedCT 14443002
English Antibiotics, Aminoglycoside, aminoglycosides, aminoglycosides (medication), aminoglycoside antibiotics, aminoglycosides antibiotics, AMINOGLYCOSIDE ANTIBACTERIALS, aminoglycoside antibiotic, Aminoglycoside -class of antibiotic- (substance), Aminoglycoside -class of antibiotic-, Aminoglycoside, NOS, Aminoglycosides, Aminoglycoside Agents, Aminoglycoside Antibiotic, Aminoglycoside Drugs
Spanish aminoglucósido (clase de antibiótico) (sustancia), aminoglucósido (clase de antibiótico)

Ontology: Gentamicin Sulfate (USP) (C0546866)

Definition (CHV) a kind of antibiotics
Definition (CHV) a kind of antibiotics
Definition (MSH) A complex antibiotic substance produced by MICROMONOSPORA purpurea, with three components: gentamicin C1, C2 , and C1A sulfates.
Definition (NCI) The sulfate salt form of gentamycin, a broad-spectrum aminoglycoside antibiotic complex produced by the fermentation of Micromonospora purpurea or M. echinospora, with antibacterial activity. Gentamicin is a thermostable complex containing the gentamicins C1, C1a, C2, C2a and C2b.
Definition (NCI) A broad-spectrum aminoglycoside antibiotic produced by fermentation of Micromonospora purpurea or M. echinospora. Gentamicin is an antibiotic complex consisting of four major (C1, C1a, C2, and C2a) and several minor components. This agent irreversibly binds to the bacterial 30S ribosomal subunit. Specifically, this antibiotic is lodged between 16S rRNA and S12 protein within the 30S subunit. This leads to interference with translational initiation complex, misreading of mRNA, thereby hampering protein synthesis and resulting in bactericidal effect. Aminoglycosides are mostly ineffective against anaerobic bacteria, fungi and viruses.
Definition (CSP) complex of three different closely related aminoglycoside sulfates, obtained from Micromonospora purpurea and related species; broad-spectrum antibiotics; may cause ear and kidney damage; they act to inhibit protein synthesis.
Concepts Antibiotic (T195) , Carbohydrate (T118)
MSH D005839
SnomedCT 332830003, 330929002, 255967008, 330314006, 324117008, 387321007, 57752001, 2249001, 411310000
LNC LP15747-6, MTHU004260
English Gentamicins, Sulfate, Gentamicin, Gentamicin [ear], Gentamicin [eye], Gentamicin [infections], Gentamicin [skin], Gentamicin Sulfate (USP), gentamicin sulfate, gentamicin sulfate (medication), gentamicins (medication), gentamicins, GENTAMICIN, GENTAMICIN SULFATE, gentamicin, gentamicin sulphate, gentamycin sulphate, gentamycin sulfate, Gentamycin Complex, Gentamicin [skin] (product), Gentamicin [ear] (product), Gentamycin sulfate (substance), Gentamicin [eye] (product), Gentamicin [infections] (product), Gentamicin Sulfate [Chemical/Ingredient], Gentamicin, Gentamycin, Gentamicin sulfate, Gentamicin product, Gentamicin (product), Gentamicin (substance), Gentamicin sulfate (substance), Gentamicin sulphate, gentamycin, GM, Gentamicin [ear] (substance), Gentamicin [eye] (substance), Gentamicin [infections] (substance), Gentamicin [skin] (substance), Gentamycin sulfate, Gentamycin sulphate, Gentamycin sulfate (product), Gentamicin Sulfate
Portuguese Sulfato de Gentamicina (USP)
Spanish Sulfato de Gentamicina (USP), gentamicina (uso ótico), gentamicina (uso dermatológico), gentamicina (uso oftálmico), gentamicina (uso ótico) (producto), gentamicina (uso oftálmico) (producto), gentamicina [antinfeccioso], gentamicina (uso dermatológico) (producto), gentamicina [antinfeccioso] (producto), gentamicina, sulfato (sustancia), gentamicina (oftálmico) (producto), gentamicina (oftálmico), gentamicina (oído) (producto), gentamicina (oído), gentamicina (piel) (producto), gentamicina (piel), gentamicina (producto), gentamicina (sustancia), gentamicina [infecciones] (producto), gentamicina [infecciones], gentamicina, sulfato de gentamicina (sustancia), sulfato de gentamicina, gentamicina, sulfato, gentamicina, sulfato (producto)
German Gentamycinsulfat, Gentamycine, Gentamicinsulfat, Gentamicin, Gentamycin, Gentamicine
Czech gentamiciny
Finnish Gentamysiinit
Russian GENTAMITSINY
Japanese ゲンタマイシン, ゲンタミシン
Croatian GENTAMICINI
French Gentamicine, Gentamycine
Italian Gentamicine

Ontology: Garamycin (C0699088)

Concepts Antibiotic (T195) , Carbohydrate (T118)
MSH D005839
German Garamicin, Garamycin
English garamycin, Garamycin