Gentamicin

Question 1

Gentamicin Indications

Answer 1

Severe sepsis
HAP
Prostatisis
Complicated UTI
Pseudomonas

Question 2

Gentamicin spectrum of activity

Answer 2

Gram negative - E.coli, Klebsella, proteus, PSEUDOMONAS

Not effective alone v gram positive

Question 3

Gentamicin MOA

Answer 3

iRREVERSIBLY bind to ribosomes inhibiting protein synthesis

Question 4

Gentamicin SE

Answer 4

• Impairs neuromuscular transmission
• Irreversible ototoxicity
• Nephrotoxicity
• N+V
• C.DIFF
• Electrolyte disturbances

Question 5

CI and cautions of Gentamicin

Answer 5

CI: Myasthenia gravis

Avoid concomitant use with ototoxic drugs (cisplatin, furosemide) and nephrotoxic drugs (vanc, ciclosporin)

Question 6

Multiple daily dose regimen gentamicin

Answer 6

One-hour (peak) serum concentration should be 5 to 10mg/L (3 to 5 mg/L for endocarditis)
* Pre-dose (trough) concentration should be
< 2mg/L (< 1mg/L for endocarditis

Question 7

Gentamicin trough and peaks

Answer 7

If trough is high then extend dosing regimen
If peak is high then reduce the dose

Question 8

Gentamicin monitoring

Answer 8

Renal
Auditory + Vestibular
Conc

Question 9

MHRA - Gentamicin

Answer 9

MHRA/CHM advice: potential for histamine-related adverse drug reactions with some batches (November 2017)
With intramuscular use or intrathecal use or intravenous use
Following reports that some batches of gentamicin sulphate active pharmaceutical ingredient (API) used to manufacture gentamicin may contain higher than expected levels of histamine, which is a residual from the manufacturing process, the MHRA advise to monitor patients for signs of histamine-related adverse reactions; particular caution is required in patients taking concomitant drugs known to cause histamine release, in children, and in patients with severe renal impairment.