TAM (Treatments and Medicines) NHS Highland
Indication
- Treatment of gram negative bacterial infection
|
Age |
Dose | Frequency | Comments |
| Less than 7 days after birth | 5mg/kg | 36 hourly |
Initial starting dose. Adjust according to Therapeutic Drug Monitoring (see below). |
| IF less than 7 days after birth AND more than 32 weeks gestation, appears very unwell or blood culture grows Gram negative bacteria |
5mg/kg |
24 hourly Except in renal impairment. |
|
|
7 days or more after birth |
5mg/kg | 24 hourly |
Supply & reconstitution
- Available already reconstituted 20mg/2mL per vial/ampoule.
- No further dilution required.
Administration
- Give by slow IV injection over 3 to 5 minutes.
- Ensure adequate flushing if patient is also prescribed a penicillin or cephalosporin, due to incompatibilities.
Compatibility / incompatibility
- See Injectable Medicines Guide: Medusa Homepage (wales.nhs.uk).
Cautions & contra-indications
- See BNFC for full information
- Hypersensitivity to gentamicin or other ingredients.
Adverse drug reactions
- see BNFC for full information
- Nephrotoxicity
Prescribers should assess prior to prescribing and monitor whilst on treatment.
And check child is passing urine.
Nephrotoxicity may be compounded by other agents, eg, amphotericin, cephalosporins, ciclosporin, ibuprofen, indometacin, tacrolimus, vancomycin. - Auditory and vestibular function
Prescribers should monitor for signs of ototoxicity eg hearing loss, and refer to audiology if it develops, or if gentamicin is continued for more than 7 days.
Stop gentamicin if ototoxicity occurs, and refer to microbiology or an infection specialist for advice on future therapy.
Ototoxicity may be compounded by, eg, furosemide, indometacin and vancomycin; monitor renal function & fluid balance closely. - Venous irritation
This medicine has a low pH and may cause venous irritation and tissue damage in cases of extravasation.
If a central venous access device is unavailable, administer via a large peripheral vein.
Re-site cannula at first signs of inflammation.
Interactions
- see BNFC for full information
- Enhances the effects of non-depolarising muscle relaxants, eg, atracurium
MHRA / CHM advice
- (Jan 2021): Aminoglycosides: increased risk of deafness in patients with mitochondrial mutations
- (Nov 2017): Potential for histamine-related adverse drug reactions with some batches
Therapeutic drug monitoring
If a second dose of gentamicin is required: measure the trough level IMMEDIATELY BEFORE the second dose
| NO concerns about renal function |
Renal impairment OR any concern about renal function |
| Give the second dose WITHOUT waiting for the trough result. | WAIT for the trough result before giving the second dose OR discuss antibiotic choice with the consultant. |
|
Action to take based on trough levels at 2nd dose |
|||
| Less than 1mg/L | More than 1mg/L and less than 2mg/L | 2mg/L or more | |
| 36 hourly dosing | 24 hourly dosing | ||
| No further routine monitoring required |
ONLY 5 days of treatment planned: No further routine monitoring required.
|
Take a trough level before 4th dose |
Delay the next dose by 12 hours and re-check trough level. If less than 2mg/L, continue but extend the dosing interval by 12 hours for subsequent doses, ie, 36 to 48 hourly. Take a trough level before 4th dose. |
- Repeat CRP 18 to 24 hours after starting antibiotics and first sample for CRP.
- If CRP remains low (less than 10) and baby is clinically well, discontinue the gentamicin.
- If blood cultures remain negative but CRP has risen above 10, duration of antibiotics will be 5 to 7 days. Exact duration depends on if baby has been unwell and on return of CRP towards normal values
See: Prevention and management of neonatal sepsis guideline for further detail.
|
Action to take based on trough levels at 4th (or any subsequent) dose |
|
| Less than 1mg/L | 1mg/mL or more |
| No further routine monitoring required |
Delay the next dose by 12 hours and re-check trough level. If less than 1mg/mL extend the dosing interval by 12 hours for subsequent doses, ie, 36 hourly to 48 hourly, 24 hourly to 36 hourly. |
|
Follow this advice for subsequent doses after result of trough level at 4th dose available. |
|
A peak level may be measured if required. See BNFc.