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Gentamicin Dosing Guide
- 1. Gentamicin A presentation for junior doctors and pharmacists
- 24. An example of how to complete the Yorkshire Hartford Gentamicin Regimen drug chart
- 26. Complete the patient details at the top of the chart
- 27. Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50
- 30. Complete the allergy/adverse drug effects box Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 58kg
- 31. Check the patient is not excluded. Calculate the Cockroft and Gault estimate of creatinine clearance to ensure that the patient has sufficient renal function to receive this regimen. (For this patient, they have a serum of creatinine of 90micromol/L and a creatinine clearance of 56ml/min) Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 58kg NKDA ADr 1/5/09
- 32. Use the lower of the Actual Weight or Ideal Body Weight to calculate the 7mg/kg dose, rounded to the nearest 40mg. Alternatively, use the table on the reverse of the chart to determine the dose. Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 58kg NKDA ADr 1/5/09
- 33. The first dose is administered to the patient. It is important that the time the infusion starts is recorded. The first blood test is due 6-14 hours after this time. Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 58kg NKDA ADr 1/5/09 400mg ADr 1/5/09
- 34. The time the sample is actually taken must be recorded. Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 58kg NKDA ADr 1/5/09 400mg ADr 1/5/09 9am KF AS 1/5/09 15.00- 23.00
- 35. When the gentamicin result is available, record this along with today's serum creatinine. Serum creatinine must be measured daily. Rose Tyler 3 Smith 123456 9876641230 60kg 5'6" 11/4/50 58kg NKDA ADr 1/5/09 400mg ADr 1/5/09 9am KF AS 1/5/09 15.00- 23.00 1/5/09 19.00 10
- 36. Refer to microbiology or pharmacy if serum creatinine is rising sharply Plot the gentamicin level against the hours-post-dose on the chart on the back. This chart also shows when the next level is due. 1/5/09 Smith 60kg Rose Tyler 3 123456 9876641230 5'6" 11/4/50 58kg NKDA ADr 400mg ADr 1/5/09 9am KF AS 1/5/09 15.00- 23.00 1/5/09 19.00 10 5.5 85
- 38. 2/5/09 4/5/09 21:00 09:00 400mg ADr The process continues until gentamicin is no longer required. Remember to review the need for IV antibiotics on a daily basis. 1/5/09 Smith 60kg Rose Tyler 3 123456 9876641230 5'6" 11/4/50 58kg NKDA ADr 400mg ADr 1/5/09 9am KF AS 1/5/09 15.00- 23.00 1/5/09 19.00 10 5.5 85
- 43. Standard: Pre-dose <2mg/L, Post-dose 6-10mg/L Synergistic dosing for endocarditis: Pre-dose <1mg/L, Post-dose 3-5mg/L No target - use the nomogram to identify the patient's required dosing interval. Target concentrations Just before the dose (pre-dose sample) and 1 hour (post-dose sample) One sample taken 6-14 hours after the infusion commences Blood levels taken Bolus over at least 3 minutes Infusion in 50-100ml Sodium Chloride 0.9% over 30 minutes Administration Adults: 2mg/kg loading dose, then refer to pharmacy or microbiology for maintenance dose Synergistic dosing for endocarditis 1mg/kg TDS (or less frequently) Paediatrics: 2.5mg/kg TDS Adjust dose and frequency based upon gentamicin serum concentration 7mg/kg, with dose frequency altering according to nomogram based upon gentamicin serum concentration Initial Dose Pharmacokinetic Dosing Hartford Extended Interval dosing Summary
Notas del editor
- First aminoglycoside (streptomycin) discovered in 1943. Produced by species of Streptomyces and Micromonospora. Those derived from the latter e.g. gentamicin have an ‘i’ in the ‘mycin’ suffix. Composed of linked ring of amino sugars and aminoosubstituted cyclic polyalcohol (aminocyclitol). This moiety usually consists of 1 of 2 streptamine derivatives; streptidine or deoxystreptidine. The latter may be subdivided into the neomycin and kanamycin groups. The latter includes gentamicin, tobramycin and netilmicin. Gentamicin is active against staphylococci, and gram-negative bacilli including pseudomonas spp. Aminoglycosides penetrate poorly into mammalian cells, so of limited value in infections caused by intracellular bacteria.
- Cause misreading of mRNA codons, producing defective proteins which may affect cell membrane integrity, may cause formation of non-functioning initiation complexes, or inhibition of translocation during formation of polypeptides. None of these theories fully explains potent bactericidal activity of aminoglycosides compared with other protein synthesis inhibitors. Enter bacteria by active transport involving respiratory quinones. These are absent in streptococci, explaining their resistance, but action against them may be improved by synergy with penicillins.
- May cause neuromuscular blockade and respiratory paralysis with curare-type muscle relaxants.
- Indicated in urinary-tract infections, chest infections, bacteraemia, septicaemia, and other systemic infections due to sensitive organisms. Usually active against most strains of : Escherichia coli, Klebsiella spp., Proteus spp. (indole positive and indole negative), Pseudomonas aeruginosa, Staphylococci, Enterobacter spp., Citrobacter spp and Providencia spp. Local guidelines recommend use in: Acute, hospital acquired UTIs; Pyelonephritis; Acute prostatitis; Severe diabetic foot; Listeria meningitis (with amoxicillin); Peritonitis (with Vanc and Met); Pelvic inflammatory disease; Pueperal sepsis or TOP; Infective endocarditis (with fluclox or benpen); Septicaemia (with Taz, vanc or dapto); Neutropenic sepsis; Surgical, orthopaedic and head and neck prophylaxis.
- Post antibiotic effect is the apparent continuation of bacterial kill after the drug is cleared. Gentamicin is a concentration-dependant killer.
- Most preparations only licensed for multiple-dose per day administration.