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Gentamicin information from DrugsUpdate  

See Available Brands of Gentamicin in India

P - Contraindicated in pregnancy
L - Caution when used during lactation

Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative bacteria. However, gentamicin is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila bacterial infections (because of the risk of the patient going into shock from lipid A endotoxin found in certain gram negative organisms).

Gentamicin is one of the few heat-stable antibiotics that remain active even after autoclaving, which makes it particularly useful in the preparation of certain microbiological growth media.

Treatment of susceptible bacterial infections, normally Gram-negative bacteria including Pseudomonas, Proteus, Serratia, and Gram-positive Staphylococcus.

Gentamicin is the only heat-stable antibiotic, hence its use during orthopaedic surgery when high temperatures are required for the setting of cements (e.g. hip replacements).

Pharmacodynamics

Pharmacokinetics

Gentamicin is an aminoglycoside that binds to 30s and 50s ribosomal subunits of susceptible bacteria disrupting protein synthesis, thus rendering the bacterial cell membrane defective.

Absorption
Poorly absorbed from the GI tract (oral); rapid (IM); systemic absorption from denuded skin and burns (topical) and from wounds, body cavities, joints (instillation, irrigation).

Distribution
Diffuse mainly into the extracellular fluids; but only small amounts enter the CSF even when the meninges are inflamed. Poorly diffused (Ophthalmic), readily diffused (perilymph of the inner ear). Crosses the placenta and enters the breast milk. Accumulates mainly in the kidneys.

Excretion
Via the urine by glomerular filtration (virtually unchanged); 2-3 hours (elimination half-life).

Gentamicin Indications / Gentamicin Uses

Information Not Available

Gentamicin Adverse Reactions / Gentamicin Side Effects

Dizziness or vertigo; acute renal failure, interstitial nephritis, acute tubular necrosis; electrolyte imbalances; transient elevation of serum bilirubin and aminotransferases; purpura; nausea, vomiting; convulsions, mental depression, hallucinations. Atrophy or rat necrosis at inj sites.

Potentially Fatal: Nephrotoxicity, ototoxicity and neuromuscular blockade (may unmask or aggravate myasthaenia gravis).

Precautions

Warnings
Neurotoxicity

Manifests as both auditory and vestibular ototoxicity, and primarily occurs in patients with pre-existing renal damage or in healthy renal function with prolonged therapy. Partial or total irreversible deafness may continue to develop after drug is stopped. Other features of neurotoxicity include paresthesias, twitching, and seizures.

Nephrotoxicity

Usually reversible.
Closely monitor renal and eighth nerve function in patients with suspected renal function impairment. Monitor peak and trough concentrations. Dosage adjustments required in renal function impairment.


Overdosage
Haemodialysis may be useful in the removal of gentamicin from the blood, and is important if renal function is, or becomes compromised. Rate of removal is lower by peritoneal dialysis compared to haemodialysis.

Special Precautions

Concurrent use of neuromuscular blocking agents; myasthenia gravis, parkinsonism; conditions predisposing to ototoxicity and nephrotoxicity; lactation. Monitor plasma concentrations of gentamicin in patients receiving high doses or prolonged courses, in infants, elderly, patients with renal impairment, cystic fibrosis or significant obesity. Monitor auditory and renal functions.

Other Drug Interactions

Synergistic with ampicillin, benzylpenicillin and other β-lactam antibiotics. Increased risk of severe respiratory depression when used concurrently with anaesthetics or opioids. May reduce renal clearance of zalcitabine and induce hypocalcaemia when used with biphosphonates. Not to be used with agalsidase alfa or beta as it may inhibit α-galactosidase activity.

Potentially Fatal: Increased incidence of ototoxicity when combined with ethacrynic acid and furosemide. Cephalosporins, ciclosporin, cisplatin, vancomycin, hydrocortisone and indometacin potentiate nephrotoxicity. Potentiates neuromuscular blocking agents.

Other Interactions

Information Not Available

Dosage

Intramuscular
Susceptible infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 weeks: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.

Intramuscular
Biliary tract infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 weeks: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                   Administer every 8 hours.
40-60                Administer every 12 hours.
20-40                Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular
Brucellosis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 weeks: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular
Cat scratch disease
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular

Cystic fibrosis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 wk-12 years: 2 mg/kg every 8 hours.


Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours.
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Endocarditis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 wk-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.

Intramuscular
Endometritis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.


Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Gastroenteritis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 weeks: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours.
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Granuloma inguinale
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 wk-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Listeriosis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 wk-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Meningitis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                 Administer every 8 hours.
40-60              Administer every 12 hours.
20-40              Administer every 24 hours.
<20                Loading dose, monitor levels.


Intramuscular
Otitis external
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24hours.
<20                 Loading dose, monitor levels.


Intramuscular
Pelvic inflammatory disease
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular

Peritonitis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular
Plague
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 yr: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular
Pneumonia
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Septicaemia
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Skin infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 weeks-12 years: 2 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours.
40-60               Administer every 12 hours.
20-40               Administer every 24 hours.
<20                  Loading dose, monitor levels.


Intramuscular
Urinary tract infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hours for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hours; 2 wk-12 yr: 2 mg/kg every 8 hours
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60                Administer every 12 hours
20-40                Administer every 24 hours
<20                  Loading dose, monitor levels.


Intramuscular
Prophylaxis of surgical infections
Adult: 120 mg before induction of anaesthesia, in combination with penicillin, vancomycin or teicoplanin .
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)    Dosage Recommendation
≥60                  Administer every 8 hours
40-60               Administer every 12 hours
20-40               Administer every 24 hours
<20                  Loading dose, monitor levels.

Ophthalmic
Superficial ophthalmic infections
Adult: Instil 1-2 drops of a 0.3% soln into the infected eye/s every 4 hours or up to 2 drops every hours in severe infections. Alternatively, apply a small amount of 0.3% oint bid-tid into the affected eye.

Topical/Cutaneous
Bacterial skin infections
Adult: As a 0.1% cream; Apply to the affected area 3-4 times daily.

Food(before/after)

Information Not Available

List of Contraindications

Gentamicin and Pregnancy

Contraindicated in pregnancy

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Gentamicin and Lactation

Caution when used during lactation

Gentamicin and Children

Use cautiously in premature infants and newborns because of renal immaturity.

Gentamicin and Geriatic

Drug levels and renal function must be monitored closely.

Gentamicin and Other Contraindications

History of hypersensitivity to aminoglycoside; pregnancy; hepatic impairment, perforated ear drum.

Storage

Intramuscular
Store at 15-30°C.

Ophthalmic
Store at 2-30°C.

Topical/Cutaneous
Store at 2-30°C.

Lab interference

Intramuscular
Store at 15-30°C.

Ophthalmic
Store at 2-30°C.

Topical/Cutaneous
Store at 2-30°C.

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