Gentamicin dosing

Del Priore G, Jackson-Stone M, Shim EK, Garfinkel J, Eichmann MA, Frederiksen MC. A comparison of once-daily and eight hour gentamicin dosing in the treatment of postpartum endometritis. Obstet Gynecol 1996 87 994-1000. 

Lesar TS, Rotschafer JC, Strand LM, Solem LD, Zaske DE. Gentamicin dosing errors with four commonly used nomograms. JAMA 1982 248(10) 1190-3. 

In horses, 75-100% of a gentamicin dose is excreted unchanged in the urine in the first 8-24 h after administration. The half-life is 1-2 h and is longer in neonatal foals than in older foals and adult horses. Any gentamicin that accumulates in the renal cortical tissue is eliminated slowly however, these levels are often below the limits of quantification of the assays used and are, therefore, not demonstrated in pharmacokinetic studies. 

Gavalda J, Pahissa A, Almirante B, et al. Effect of gentamicin dosing interval on therapy of viridans streptococcal experimental endocarditis with gentamicin plus penicillin. Antimicrob Agents Chemother 1995 39 2098-2103. 

Marangos MN, Nicolau DP, QuintiUani R, Nightingale CH. Influence of gentamicin dosing interval on the efficacy of penicillin-containing regimens in experimental Enterococcus faecalis endocarditis. J Antimicrob Chemother 1997 39 519-522. 

D. L. Frazier, J.E. Riviere. Gentamicin Dosing Strategies for Dogs with Subclinical Renal Dysfunction. Antimicrobial Agents and Chemotherapy, Vol.31, pgs.1929-1934,1987. 

Gentamicin 120 mg intravenous piggyback every 12 hours (dose discontinued after 3 days)... 

Gram-negative rods Tobramycin 3-14 mg/mL or Gentamicin 3-14 mg/mL or Ceftazidime SO mg/mL or Fluoroquinolones 3 mg/mL Less severe keratitis may use less frequent dosing Antibiotics may be alternated each hour for ulcers and contact lens... 

Streptococcus gentamicin (5 mg/kg per day, dosing based on serum levels) Alternative Therapies Trimethoprim-sulfamethoxazole (TMP-SMX) 10-20 mg/kgTMP IV per day in divided doses every 6-8 hours or meropenem Standard Therapy TMP-SMX Rash, Stevens-Johnson syndrome, bone marrow suppression, nausea/vomiting, hepatotoxicity 14-21... 

For enterococci, it is imperative to determine species and antibiotic susceptibilities. If the organism is susceptible to penicillin and vancomycin, treatment may consist of high-dose penicillin G, ampicillin, or vancomycin plus gentamicin (see Table 71-6). Treatment length is usually 4 to 6 weeks, with the aminoglycoside used over the entire course. As resistance develops to penicillin, ampicillin and vancomycin remain treatment options. Once the isolate becomes resistant to ampicillin, vancomycin is considered the treatment of choice. 

Gentamicin should be administered in close proximity to vancomycin, nafcillin, or oxacillin dosing. cPediatric dose should not exceed that of a normal adult. 

Clindamycin 900 mg IV every 8 hours and gentamicin, loading dose IV or IM (2 mg/kg) followed by maintenance dose (1.5 mg/kg) every 8 hours (a single daily dose may be used)... 

Dual therapy with Cefepime, ceftazidime, imipenem, meropenem, Gentamicin or tobramycin 2 mg/kg loading dose... 

The in vivo protective activity of rifaximin was studied in mice, infected experimentally by intraperitoneal inoculation of S. aureus Colliva and compared to that of rifampicin (a systemic rifamycin) and gentamicin (a poorly absorbed aminoglycoside) [74]. After oral administration, only rifampicin was effective whereas the other two compounds were inactive at doses up to 10 mg/kg. However, when injected subcutaneously, rifaximin displayed a good therapeutic efficacy (table 2). While confirming its antibacterial activity, these results clearly indicate that rifaximin, like gentamycin, is poorly absorbed after oral administration. 

Recommended therapy in the uncomplicated case caused by fully susceptible strains is 4 weeks of either high-dose penicillin G or ceftriaxone, or 2 weeks of combined therapy with high-dose penicillin G plus gentamicin (Table 37-3). 

---