Cidomycin, Garamycin, G-Mycin, Jenamicin
Treatment of serious gram-negative bacterial infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated. In combination with other agents in the management of serious enterococcal infections. Prevention of infective endocarditis. Topical, Ophth: Treatment of localized infections due to susceptible organisms.
Inhibits protein synthesis in bacteria at level of 30S ribosome. Therapeutic Effects: Bactericidal action. Spectrum: Notable for activity against Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Proteus, Serratia, Acinetobacter, Staphylococcus aureus. In treatment of enterococcal infections, synergy with a penicillin is required. Not active against Streptococci, Anaerobes.
Adverse Reactions/Side Effects
CNS: ataxia, vertigo. EENT: ototoxicity (vestibular and cochlear). GU: nephrotoxicity. MS: muscle paralysis (high parenteral doses). Misc: hypersensitivity reactions.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Report any muscle weakness or paralysis that occurs following injection of high doses.
Monitor signs of ataxia and vertigo that might affect gait, balance, and other functional activities. Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.
Monitor signs of ototoxicity, including hearing loss, tinnitus, and balance problems (See Appendix E for fall assessment and prevention). Report these signs to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.
Advise patient to report signs of nephrotoxicity, including blood or pus in urine, decreased urine output, fatigue, and weight gain from fluid retention.
Absorption: Well absorbed after IM administration. IV administration results in complete bioavailability. Some absorption follows administration by other routes.
Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Poor penetration into CSF.
Metabolism and Excretion: >90% excreted unchanged by kidneys.
Half-life: Neonates <7 days: 3–11.5 hr; Neonates 7–30 days: 3–6 hr; Infants: 3–5 hr; Children: 1–3 hr; Adolescents: 0.5–2.5 hr; Adults: 2–4 hr (increased in renal impairment).
TIME/ACTION PROFILE (blood levels*)
|ROUTE ||ONSET ||PEAK ||DURATION |
|IM ||rapid ||30–90 min ||8–24 hr |
|IV ||rapid ||15–30 min† ||8–24 hr |
Contraindicated in: Hypersensitivity to gentamicin or other aminoglycosides; Most parenteral products contain bisulfites and should be avoided in patients with known intolerance; Products containing benzyl alcohol should be avoided in neonates.
Use Cautiously in: Renal impairment (dosage adjustments necessary; blood level monitoring useful in preventing ototoxicity and nephrotoxicity); Hearing impairment; Geriatric patients (difficulty in assessing auditory and vestibular function; age-related renal impairment); Neuromuscular diseases such as myasthenia gravis; Pregnancy and lactation; Neonates (increased risk of neuromuscular blockade; difficulty in assessing auditory and vestibular function; immature renal function) and neonates on extracorporeal oxygenation (ECMO) (require dose adjustments).
Drug-Drug: Inactivated by penicillins and cephalosporins when coadministered to patients with renal insufficiency. Possible respiratory paralysis after inhalation anesthetics or neuromuscular blockers. Increased incidence of ototoxicity with loop diuretics. Increased incidence of nephrotoxicity with other nephrotoxic drugs.
Many regimens are used; most involve dosing adjusted on the basis of blood level monitoring and assessment of renal function.
IM, IV (Adults): 1–2 mg/kg q 8 hr (up to 6 mg/kg/day in 3 divided doses); Once-daily dosing (unlabeled)—4–7 mg/kg q 24 hr.
IM, IV (Children >5 yr): 2–2.5 mg/kg/dose q 8 hr. Once daily—5–7.5 mg/kg/dose q 24 hr. Cystic fibrosis—2.5–3.3 mg/kg/dose q 6–8 hr. Hemodialysis—1.25–1.75 mg/kg/dose postdialysis.
IM, IV (Children 1 mo–5 yr): 2.5 mg/kg/dose q 8 hr. Once daily5–7.5 mg/kg/dose q 24 hr. Cystic fibrosis—2.5–3.3 mg/kg/dose q 6–8 hr. Hemodialysis—1.25–1.75 mg/kg/dose postdialysis.
IM, IV (Neonates full term and/or >1 wk): Weight < 1200 g—2.5 mg/kg/dose q 18–24 hr. Weight 1200–2000 g—2.5 mg/kg/dose q 8–12 hr. Weight > 2000 g—2.5 mg/kg/dose q 8 hr. ECMO—2.5 mg/kg/dose q 18 hr, subsequent doses based on serum concentrations. Once daily—3.5–5 mg/kg/dose q 24 hr.
IM, IV (Neonates premature and/or ≤1 wk): Weight < 1000 g—3.5 mg/kg/dose q 24 hr. Weight 1000–1200 g—2.5 mg/kg/dose q 18–24 hr. Weight > 1200 g—2.5 mg/kg/dose q 12 hr. Once daily—3.5–4 mg/kg/dose q 24 hr.
Intrathecal (Adults): 4–8 mg/day.
Intrathecal (Infants >3 mo and Children): 1–2 mg/day.
Intrathecal (Neonates): 1 mg/day.
Topical (Adults and Children >1 mo): Apply cream or ointment 3–4 times daily.
IM, IV (Adults): Initial dose of 2 mg/kg. Subsequent doses/intervals dependent on blood level monitoring and renal function assessment.
Injection: 10 mg/mL, 40 mg/mL. Premixed injection: 40 mg/50 mL, 60 mg/50 mL, 60 mg/100 mL, 70 mg/50 mL, 80 mg/50 mL, 80 mg/100 mL, 90 mg/100 mL, 100 mg/50 mL, 100 mg/100 mL, 120 mg/100 mL. Topical cream: 0.1%. Topical ointment: 0.1%.