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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIBACTERIALS FOR SYSTEMIC USE › AMINOGLYCOSIDE ANTIBACTERIALS › Other aminoglycosides
gentamicin
J01GB03
Forms & Strengths
- Injectable solution: 10 mg/mL, 40 mg/mL
- Intrathecal/Intraventricular: 2 mg/mL
- Ophthalmic solution: 0.3%
- Ophthalmic ointment: 0.3%
- Topical cream/ointment: 0.1%
Adult Dosing
- Systemic (IV/IM): 3 to 5 mg/kg/day divided every 8 hours or once-daily (extended-interval) dosing of 5 to 7 mg/kg every 24 hours based on renal function and drug levels
- Endocarditis (synergy): 1 mg/kg every 8 hours
- Intrathecal/Intraventricular: 4 to 8 mg once daily
- Ophthalmic: 1 to 2 drops in the affected eye every 4 hours up to multiple times daily; thin strip of ointment 2 to 3 times daily
Pediatric Dosing
- Neonates < 7 days: 2.5 mg/kg every 12 to 24 hours
- Neonates 7-28 days: 2.5 mg/kg every 8 to 12 hours
- Infants and Children (> 1 month): 2.5 mg/kg every 8 hours or 5 to 7.5 mg/kg once daily for systemic infections
- Ophthalmic (Pediatric): Same as adult dosing
Indications
- Treatment of serious gram-negative bacterial infections including Pseudomonas aeruginosa, Enterobacter, Klebsiella, Serratia, and E. coli
- Synergistic treatment of Enterococcal endocarditis (in combination with a cell-wall active agent)
- Treatment of pelvic inflammatory disease, neonatal sepsis, and meningitis (via intrathecal route)
- Topical treatment of superficial ocular and skin infections
Mechanism of Action
- Aminoglycoside antibiotic that irreversibly binds to the 30S ribosomal subunit of susceptible bacteria
- Interferes with the initiation complex and causes mRNA misreading, leading to inhibition of protein synthesis and bacterial cell death
- Exhibits concentration-dependent bactericidal activity and a significant post-antibiotic effect
Contraindications
- Hypersensitivity to gentamicin or other aminoglycosides
- History of serious toxic reactions (ototoxicity or nephrotoxicity) associated with aminoglycosides
- Myasthenia gravis (may exacerbate muscle weakness due to neuromuscular blockade)
Adverse Reactions
- Nephrotoxicity (manifested by rising serum creatinine, oliguria, acute tubular necrosis)
- Ototoxicity (vestibular toxicity causing dizziness/vertigo, and auditory toxicity causing tinnitus and high-frequency hearing loss)
- Neurotoxicity and neuromuscular blockade (can lead to respiratory depression)
- Local irritation, burning, or stinging with topical and ophthalmic formulations
Drug Interactions
- Concurrent or sequential use of other neurotoxic, ototoxic, or nephrotoxic drugs (e.g., amphotericin B, cisplatin, vancomycin, loop diuretics) increases toxicity risk
- Neuromuscular blocking agents (e.g., succinylcholine, rocuronium) may have their neuromuscular blockade effects potentiated
- Penicillins and cephalosporins can synergistically inactivate aminoglycosides if mixed in vitro within the same IV solution
Curated Content: Needs Vetting Before Put to Clinical Use