Gentamicin
PHARMACOKINETICS
Urine gentamicin concentrations can increase by 100 fold within an hour of IV administration and can remain at therapeutic levels for at least 72 hours after. (3)
SIDE EFFECTS
Incidence of adverse events is low (4) with several studies showing that risk of nephrotoxicity with single high dose (5mg/kg) is equal or less than intermittent conventional low dose administration (5) with one study of dosage at 4.5mg/kg showing nephrotoxicity at a similar rate with patients not recieving gentamicin. (6)
BLADDER IRRIGATION
One study used 480mg/1L, infuse 30-60ml at last catheterization of day and leave indwelling overnight (or until middle of night cath). (1) Another used 80mg in 50ml instilled nightly after a washout. (2)
Urine gentamicin concentrations can increase by 100 fold within an hour of IV administration and can remain at therapeutic levels for at least 72 hours after. (3)
SIDE EFFECTS
Incidence of adverse events is low (4) with several studies showing that risk of nephrotoxicity with single high dose (5mg/kg) is equal or less than intermittent conventional low dose administration (5) with one study of dosage at 4.5mg/kg showing nephrotoxicity at a similar rate with patients not recieving gentamicin. (6)
BLADDER IRRIGATION
One study used 480mg/1L, infuse 30-60ml at last catheterization of day and leave indwelling overnight (or until middle of night cath). (1) Another used 80mg in 50ml instilled nightly after a washout. (2)
- Lindsey Cox, Chang He, et al. "Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization." Canadian Urological Association Journal 11.9 (2017): E350.
- Abrams, P., Hashim, H., Tomson, C., Macgowan, A., Skews, R., & Warren, K. (2017). The use of intravesical gentamicin to treat recurrent urinary tract infections in lower urinary tract dysfunction. Neurourology and Urodynamics, 36(8), 2109–2116.
- Goodlet, Kellie J., Fatima Z. Benhalima, and Michael D. Nailor. "A systematic review of single-dose aminoglycoside therapy for urinary tract infection: is it time to resurrect an old strategy?." Antimicrobial agents and chemotherapy 63.1 (2019).
- Bratzler, Dale W., et al. "Clinical practice guidelines for antimicrobial prophylaxis in surgery." Surgical infections 14.1 (2013): 73-156.
- Krause, Kevin M., et al. "Aminoglycosides: an overview." Cold Spring Harbor perspectives in medicine 6.6 (2016): a027029.
- Dubrovskaya, Yanina, et al. "Single high dose gentamicin for perioperative prophylaxis in orthopedic surgery: Evaluation of nephrotoxicity." SAGE open medicine 3 (2015): 2050312115612803.