Gentamicin: Difference between revisions

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===General===
===General===
*Extended Interval
*Extended Interval
**5-7 mg/kg IV q24h
**5-7mg/kg IV q24h
**First Dose: 5-7 mg/kg IV
**First Dose: 5-7mg/kg IV
*Conventional
*Conventional
**1-1.7 mg/kg IM/IV q8h
**1-1.7mg/kg IM/IV q8h
 
===Uncomplicated [[Gonococcal]]===
*240mg IM x 1
 
===Severe [[PID]]===
*1.5mg/kg IM/IV q8h
**Start 2mg/kg IM/IV x 1
*Alt: 3-5mg/kg IM/IV q24h
*Info: Give with [[clindamycin]]


==Pediatric Dosing==
==Pediatric Dosing==
*'''All: adjust repeat dosing based on levels'''
===General (<8 Days Old)===
*'''First Dose All: 2.5mg/kg IV/IM x1'''
*<28 weeks gestation
**2.5mg/kg IV/IM q24h
**Alt: 5mg/kg IV/IM q48h
*28-29 weeks gestation
**2.5mg/kg IV/IM q18h
**Alt: 5mg/kg IV/IM q48h
*30-33 weeks gestation
**2.5mg/kg IV/IM q18h
**Alt 1: 3.5mg/kg IV/IM q24hr
**Alt 2: 4.5mg/kg IV/IM q36-48h
*34 weeks gestation
**2.5mg/kg IV/IM q18h
**Alt 1: 3.5mg/kg IV/IM q24hr
**Alt 2: 4mg/kg IV/IM q24-36h
*35-36 weeks gestation
**2.5mg/kg IV/IM q 12h
**Alt 1: 3.5mg/kg IV/IM q24
**Alt 2: 4mg/kg IV/IM q24-36h
*Full Term
**2.5mg/kg IV/IM q12h
**Alt: 4mg/kg IV/IM q24h
===General (8 Days - 1 Month)===
*'''First Dose All: 2.5mg/kg IV/IM x1'''
*<30 weeks gestation
**2.5mg/kg IV/IM q18h
**Alt: 4mg/kg IV/IM q24-36h
*30-33 weeks gestation
**2.5mg/kg IV/IM q12h
**Alt: 4mg/kg IV/IM q24
*34 weeks gestation
**2.5mg/kg IV/IM q12h
**Alt: 4mg/kg IV/IM q18h
*35-36 weeks gestation
**2.5mg/kg IV/IM q8h
**Alt: 4mg/kg IV/IM q12h
*Full term
**2.5mg/kg IV/IM q8h
**Alt: 4mg/kg IV/IM q24h
===General (1 Month -6 Months)===
*2.5mg/kg IV/IM q8h
*Alt: 6.5mg/kg IV/IM q24h
===General (>6 Months)===
*2.5mg/kg IV/IM
*Alt: 6.5-7.5mg/kg IV/IM q24h
*Use IBW if >2yo


==Special Populations==
==Special Populations==
*Pregnancy:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: D
*Lactation:
*Lactation: Probably safe
*Renal Dosing
*Renal Dosing
**Adult
**Adult
***Conventional interval dosing
****CrCl 10-50: give q12-48h
****CrCl <10: give q48-72h
****Hemodialysis: give 1-1.7mg/kg after dialysis
***Extended interval dosing
***CrCl 30-60: increase dosing interval based on levels
***CrCl <30: avoid use
**Pediatric
**Pediatric
*Hepatic Dosing
***Conventional interval dosing
**Adult
****CrCl 30-50: give q12-48h
**Pediatric
****CrCl: 10-29: Give q18-24h
****CrCl <10: give q48-72h
****Hemodialysis/peritoneal dialysis: give 2mg/kg after dialysis
***Extended interval dosing
***CrCl 30-60: increase dosing interval based on levels
***CrCl <30: avoid use
*Hepatic Dosing (Adult & Pediatric)
**Not defined


==Contraindications==
==Contraindications==
Line 40: Line 115:
*Excretion:  
*Excretion:  
*Mechanism of Action:
*Mechanism of Action:
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||R
|-
| ||[[Strep. Pneumoniae]]||R
|-
| ||[[Viridans strep]]||X1
|-
| ||Strep. anginosus gp||X1
|-
| ||[[Enterococcus faecalis]]||'''S'''
|-
| ||[[Enterococcus faecium]]||'''S'''
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||X1
|-
| ||[[Staph. Epidermidis]]||I
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||R
|-
| ||[[N. meningitidis]]||R
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||'''S'''
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||X1
|-
| ||Serratia marcescens||'''S'''
|-
| ||[[Salmonella]] sp||X1
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||X1
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||X1
|-
| ||[[Morganella sp.]]||X1
|-
| ||[[Citrobacter freundii]]||X1
|-
| ||[[Citrobacter diversus]]||X1
|-
| ||[[Citrobacter sp.]]||X1
|-
| ||[[Aeromonas sp]]||X1
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||'''S'''
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||'''S'''
|-
| ||[[Brucella sp.]]||''S+'''
|-
| ||[[Legionella sp.]]||X1
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||I
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||R
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||R
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||R
|-
| ||[[Clostridium (not difficile)]]||X1
|-
| ||[[Fusobacterium necrophorum]]||R
|-
| ||[[Peptostreptococcus sp.]]||R
|}
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
 
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]

Revision as of 05:07, 24 October 2017

General

Adult Dosing

  • All: If obese, use Adjusted Weight = IBW + 0.4 x (ABW - IBW)
  • All: Adjust repeat dosing based on levels

General

  • Extended Interval
    • 5-7mg/kg IV q24h
    • First Dose: 5-7mg/kg IV
  • Conventional
    • 1-1.7mg/kg IM/IV q8h

Uncomplicated Gonococcal

  • 240mg IM x 1

Severe PID

  • 1.5mg/kg IM/IV q8h
    • Start 2mg/kg IM/IV x 1
  • Alt: 3-5mg/kg IM/IV q24h
  • Info: Give with clindamycin

Pediatric Dosing

  • All: adjust repeat dosing based on levels

General (<8 Days Old)

  • First Dose All: 2.5mg/kg IV/IM x1
  • <28 weeks gestation
    • 2.5mg/kg IV/IM q24h
    • Alt: 5mg/kg IV/IM q48h
  • 28-29 weeks gestation
    • 2.5mg/kg IV/IM q18h
    • Alt: 5mg/kg IV/IM q48h
  • 30-33 weeks gestation
    • 2.5mg/kg IV/IM q18h
    • Alt 1: 3.5mg/kg IV/IM q24hr
    • Alt 2: 4.5mg/kg IV/IM q36-48h
  • 34 weeks gestation
    • 2.5mg/kg IV/IM q18h
    • Alt 1: 3.5mg/kg IV/IM q24hr
    • Alt 2: 4mg/kg IV/IM q24-36h
  • 35-36 weeks gestation
    • 2.5mg/kg IV/IM q 12h
    • Alt 1: 3.5mg/kg IV/IM q24
    • Alt 2: 4mg/kg IV/IM q24-36h
  • Full Term
    • 2.5mg/kg IV/IM q12h
    • Alt: 4mg/kg IV/IM q24h

General (8 Days - 1 Month)

  • First Dose All: 2.5mg/kg IV/IM x1
  • <30 weeks gestation
    • 2.5mg/kg IV/IM q18h
    • Alt: 4mg/kg IV/IM q24-36h
  • 30-33 weeks gestation
    • 2.5mg/kg IV/IM q12h
    • Alt: 4mg/kg IV/IM q24
  • 34 weeks gestation
    • 2.5mg/kg IV/IM q12h
    • Alt: 4mg/kg IV/IM q18h
  • 35-36 weeks gestation
    • 2.5mg/kg IV/IM q8h
    • Alt: 4mg/kg IV/IM q12h
  • Full term
    • 2.5mg/kg IV/IM q8h
    • Alt: 4mg/kg IV/IM q24h

General (1 Month -6 Months)

  • 2.5mg/kg IV/IM q8h
  • Alt: 6.5mg/kg IV/IM q24h

General (>6 Months)

  • 2.5mg/kg IV/IM
  • Alt: 6.5-7.5mg/kg IV/IM q24h
  • Use IBW if >2yo

Special Populations

  • Pregnancy Rating: D
  • Lactation: Probably safe
  • Renal Dosing
    • Adult
      • Conventional interval dosing
        • CrCl 10-50: give q12-48h
        • CrCl <10: give q48-72h
        • Hemodialysis: give 1-1.7mg/kg after dialysis
      • Extended interval dosing
      • CrCl 30-60: increase dosing interval based on levels
      • CrCl <30: avoid use
    • Pediatric
      • Conventional interval dosing
        • CrCl 30-50: give q12-48h
        • CrCl: 10-29: Give q18-24h
        • CrCl <10: give q48-72h
        • Hemodialysis/peritoneal dialysis: give 2mg/kg after dialysis
      • Extended interval dosing
      • CrCl 30-60: increase dosing interval based on levels
      • CrCl <30: avoid use
  • Hepatic Dosing (Adult & Pediatric)
    • Not defined

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:
  • Mechanism of Action:

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G R
Strep. Pneumoniae R
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis S
Enterococcus faecium S
MSSA S
MRSA R
CA-MRSA X1
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae R
N. meningitidis R
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp X1
Serratia marcescens S
Salmonella sp X1
Shigella sp S
Proteus mirabilis X1
Proteus vulgaris S
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis S
Brucella sp. S+'
Legionella sp. X1
Pasteurella multocida X1
Haemophilus ducreyi X1
Vibrio vulnificus I
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp R
Mycobacterium avium X1
Anaerobes Actinomyces R
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) X1
Fusobacterium necrophorum R
Peptostreptococcus sp. R

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014