gentamicin (Rx)Brand and Other Names:

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 40mg/mL
more...

Susceptible Infections

Conventional dosing

  • 3-5 mg/kg/day IV/IM divided q8hr  

Extended dosing interval (q24h+)

  • Initial: 4-7 mg/kg/dose IV qDay
  • Base dose on lean body weight
  • Subsequent doses: Consult pharmacist

Surgical Infection

Prophylaxis

Oral/pharyngeal: 1.5 mg/kg IV PLUS clindamycin 600-900 mg IV 

Ruptured viscus: 1.5 mg/kg IV q8hr PLUS clindamycin 600 mg IV q6hr

Endocarditis

Prophylaxis

GI, GU procedure: 1.5 mg/kg IV/IM <30 minutes before procedure PLUS ampicillin or vancomycin

Cystic Fibrosis

7.5-10.5 mg/kg/day IV/IM divided q8hr  

Pelvic Inflammatory Disease (Off-label)

Loading dose: 2 mg/kg IV or IM  

Maintenance dose: 1.5 mg/kg IV or IM q8hr

Mycobacterium Infection (Orphan)

Gentamicin liposome injection: For disseminated Mycobacterium avium-intracellulare infection

Orphan indication sponsor

  • Liposome Company, Inc; One Research Way; Princeton, NJ 08540

Dosing Considerations

Gentamicin may be given IV/IM

Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as on the body space where distribution of the agent will occur

Monitor peak (4-12 mg/L) and trough (1-2 mg/L)

Monitor renal and auditory function

Each regimen must be followed by at least trough level drawn on third or fourth dose, 30 minutes before dosing

May draw peak level 30 minutes after 30-minute infusion

Use ideal body weight for mg/kg/dose; more accurate than total body weight

Gentamicin is usually a first-line aminoglycoside against infections with gram-negative organisms such as Pseudomonas aeruginosa, Proteus, Escherichia coli, Klebsiella, Enterobacter, Serratia, and Citrobacter, as well as against Staphylococcus (gram- positive)

Bacterial organisms causing usceptible infections

  • Susceptible infections include the following:
  • Pseudomonas aeruginosa
  • Proteus species (indole-positive and indole-negative)
  • Escherichia coli
  • Klebsiella-Enterobacter-Serratia species
  • Citrobacter species
  • Staphylococcus species (coagulase-positive and coagulase-negative)
  • Pseudomonas aeruginosa
  • Proteus species (indole-positive and indole-negative)
  • Escherichia coli
  • Klebsiella-Enterobacter-Serratia species
  • Citrobacter species
  • Staphylococcus species (coagulase-positive and coagulase-negative)

Dosing Modifications

Renal impairment

  • CrCl >90 mL/min and <60 years: q8hr
  • CrCl 60-90 mL/min or ≥60 years: q12hr
  • CrCl 25-60 mL/min: q24hr
  • CrCl 10-25 mL/min: q48hr
  • CrCl <10 mL/min: q72hr
  • Following dialysis in ESRD

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 40mg/mL
more...

Susceptible Infections

≥5 years: 2-2.5 mg/kg/dose IV/IM q8hr 

<5 years: 2.5 mg/kg/dose IV/IM q8hr

<30 weeks' gestation

  • 0-28 days: 2.5 mg/kg/day IV/IM
  • >28 days: 3 mg/kg/day IV/IM

30-36 weeks' gestation

  • 0-14 days: 3 mg/kg/day IV/IM
  • >14 days: 5 mg/kg/day IV/IM divided q12hr

>36 weeks' gestation

  • 0-7 days: 5 mg/kg/day IV/IM divided q12hr
  • >7 days: 7.5 mg/kg/day IV/IM divided q8hr

Dosing Considerations

Monitor peak (4-12 mg/L) and trough (1-2 mg/L)

Monitor renal and auditory function

Individualization critical due to low therapeutic index

Use ideal body weight for mg/kg/dose, except in neonates (in whom actual body weight should be used)

Bacterial organisms causing susceptible infections

  • Pseudomonas aeruginosa
  • Proteus species (indole-positive and indole-negative)
  • Escherichia coli
  • Klebsiella-Enterobacter-Serratia species
  • Citrobacter species
  • Staphylococcus species (coagulase-positive and coagulase-negative)
Next

Interactions

Interaction Checker

gentamicin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            >10%

            Neurotoxicity (vertigo, ataxia)

            Gait instability

            Ototoxicity (auditory, vestibular)

            Nephrotoxicity (decreased CrCl)

            Nephrotoxicity if trough >2 mg/L

            1-10%

            Edema

            Rash

            Reddening of skin

            Itching

            <1%

            Drowsiness

            Headache

            Pseudomotor cerebri

            Photosensitivity

            Allergic reaction

            Erythema

            Anorexia

            Nausea/vomiting

            Weight loss

            Increased salivation

            Enterocolitis

            Granulocytopenia

            Agranulocytosis

            Thrombocytopenia

            Elevated LFTs

            Burning

            Stinging

            Tremors

            Muscle cramps

            Weakness

            Dyspnea

            Previous
            Next

            Warnings

            Black Box Warnings

            Neurotoxicity, manifested as bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended; high-frequency deafness usually occurs first and can be detected only with audiometric testing

            Aminoglycosides are potentially nephrotoxic; risk is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy; rarely, nephrotoxicity may not become apparent until the first few days after cessation of therapy

            Use with caution in premature infants and neonates because of renal immaturity and the resulting prolongation of serum half-life of the drug

            Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and oral use of aminoglycosides, especially when given soon after anesthesia or muscle relaxants; if blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary

            Avoid concurrent or sequential use of neurotoxic and/or nephrotoxic drugs, including other aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, paromomycin)

            Cumulative listing of drugs to avoid from all aminoglycoside package inserts includes amphotericin B, bacitracin, cephaloridine, cisplatin, colistin, polymyxin B, vancomycin, and viomycin

            Avoid potent diuretics (eg, ethacrynic acid, furosemide) because they increase risk of ototoxicity; when administered intravenously, diuretics may enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue

            Contraindications

            Prior aminoglycoside toxicity or hypersensitivity

            Cautions

            Risk of ototoxicity, neurotoxicity, nephrotoxicity

            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

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Enters breast milk; use with caution (AAP Committee states "compatible with nursing")

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Aminoglycoside antibiotic for coverage of gram-negative bacteria, including Pseudomonas species; synergistic with beta lactamase against enterococci; interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits

            Absorption

            Peak plasma time: IM (30-90 min); IV (30 min after 30-min infusion)

            Distribution

            Gentamicin crosses placenta; relative diffusion from blood into CSF is minimal even with inflammation

            CSF-to-blood level ratio: Normal meninges (minimal); inflamed meninges (10-30%)

            Protein bound: <30%

            Vd: Neonates (0.4-0.6 L/kg); children: (0.3-0.35 L/kg); adults: (0.2-0.3 L/kg); Vd increased by edema, ascites, and fluid overload and decreased by dehydration

            Elimination

            Half-life: 2-3 hr (NRF)

            Renal clearance: Directly related to renal function

            Excretion: Urine (70% recovered as unchanged drug in patients with NRF)

            Previous
            Next

            Administration

            IV Incompatibilities

            Additive: Ampho B, ampicillin, cefazolin, dopamine, furosemide, heparin

            Syringe: Ampicillin, heparin

            Y-site: Furosemide, heparin

            Not spec: Carbenicillin

            IV Compatibilities

            Additive: cimetidine, clindamycin, verapamil

            Syringe: clindamycin

            Y-site: Amiodarone, esmolol, vitamins B/C

            IV Preparation

            Dilute single dose in 50-200 mL NS or D5W

            IV Administration

            Infuse over 30 min-2 hr

            After infusion, flush line with NS or D5W

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.