Gentamicin patients

Tobramycin/Gentamicin—Patients with Normal Renal Function... 

Gram-negative coverage is indicated for patients with diabetes, HIV infection, prosthetic valves, or those receiving immunosuppressive agents (gentamicin 2 mg/kg intravenously with serum concentration monitoring). 

Patients with PVE caused by penicillin-susceptible strains of viridans streptococci require treatment for 6 weeks with penicillin G or ceftriaxone with or without gentamicin during the initial 2 weeks of therapy. However, if the organism demonstrates less susceptibility to penicillin (MIC greater than 0.12 mcg/mL), a combination therapy with penicillin G or ceftriaxone plus gentamicin should be given for the entire 6 weeks. Vancomycin remains the primary alternative if the patient is allergic to (l-lactams (e.g., penicillins, cephalosporins, etc.). 

It is important to determine (1) whether the isolate is methicillin-susceptible or methicillin-resistant and (2) whether the patient has a prosthetic valve. For patients with no prosthetic material, methicillin-susceptible staphylococci treatment should consist of a penicillinase-resistant penicillin (e.g., nafcillin or oxacillin) with or without gentamicin, and for methicillin-resistant strains, therapy should consist of vancomycin (see Table 71-4). Combination therapy with aminoglycosides, when used in these patients, typically is given only during the first 3 to 5 days of therapy. In the absence of prosthetic material, some treatment guidelines do not recommend combination therapy against MRSA. However, many clinicians may combine either gentamicin or rifampin with vancomycin if the patient is unresponsive to monotherapy. 

Erythromycin is considered the optimal drug for treatment of Campylobacter infections. The rate of resistance of Campylobacter to erythromycin remains low. Other advantages of this drug include ease of administration, low cost, lack of major toxicity, and narrow spectrum of activity.14 The recommended dosage for adults is 250 mg orally four times daily or 500 mg orally twice daily for 5 to 7 days. For very ill patients, treatment with gentamicin, imipenem, cefotaxime, or chloramphenicol is indicated, but susceptibility tests should be performed. 

A 43-year-old male in the surgical ICU after exploratory laparotomy following a motor vehicle accident develops fever that is unresponsive to broad-spectrum antibacterial therapy (piperacillin-tazobactam 3.75 g every 6 hours, gentamicin 120 mg every 8 hours, and vancomycin 1 g every 12 hours). The patient has a central venous catheter and a Foley catheter. Blood cultures are negative at the time, but the patient has yeast growing in the sputum and urine. Laboratory studies reveal a white blood cell count of 11,300 cells/mm3 (11.3 x 109/L). 

Vancomycin hydrochlo- Pediatic dose penicillin 200,000 units/kg per 24 hours IV in four to six equally divided doses ceftriaxone 100 mg/kg per 24 hours IV/IM in one dose gentamicin 3 mg/kg per 24 hours IV/IM in one dose or three equally divided doses 30 mg/kg per 24 hours IV in two equally divided doses not to exceed 2 g/ 4 1 B (second option to single daily dose) Vancomycin therapy recommended only for patients unable to tolerate... 

Vancomycin is effective and is the drug of choice for the patient with a history of immediate-type hypersensitivity reaction to penicillin. When vancomycin is used, the addition of gentamicin is not recommended. 

The recommended therapy for patients with left-sided IE caused by methicillin-sensitive S. aureus (MSSA) is 4 to 6 weeks of nafcillin or oxacillin, often combined with a short course of gentamicin (Table 37-6). 

Penicillin or ceftriaxone together with gentamicin has not demonstrated superior cure rates compared with monotherapy with penicillin or ceftriaxone for patients with highly susceptible strain gentamicin therapy should not be administered to patients with creatinine clearance of less than 30 mL/min... 

Dosages recommended are for patients with normal renal function See Table 37-3 for appropriate dosage of gentamicin. cPediatric dose should not exceed that of a normal adult. 

Enterococcal endocarditis ordinarily requires 4 to 6 weeks of high-dose penicillin G or ampicillin, plus gentamicin for cure (Table 37-8). A 6-week course is recommended for patients with symptoms lasting longer than 3 months and those with PVE. 

Vancomycin hydrochloride13, plus Gentamicin sulfate 30 m kg per 24 hours IV in 2 equally divided doses 6 IB Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin... 

Drugs Use streptomycin at 15 mg/kg lean body mass intra-muscular every twenty-four hours for ten to fourteen days or use gentamicin at 5 mg/kg lean body mass intra-venous every twenty-four hours for ten to fourteen days or use gentamicin at 1.75 mg/kg lean body mass intra-venous every eight hours for ten to fourteen days or use ciprofloxacin at 400 mg intra-venous every twelve hours (oral therapy may be given at 750 mg orally every twelve hours after the patient is clinically improved, for completion of a ten to fourteen-day course of therapy) or use doxycycline at 200 mg intra-venous loading dose followed by 100 mg intra-venous every twelve hours (oral therapy may be given at 100 mg orally every twelve hours after the patient is clinically improved, for completion of a ten to fourteen-day course of therapy. 

Hodson, M.E., Penketh, A.R. and Batten, J.C. (1981). Aerosol carbenicillin and gentamicin treatment of Pseudomonas aeruginosa infection I patients with cystic fibrosis. Lancet 2 1137-1139. 

Gentamicin is shown to have a Vd of 0.25 L per kg of the body weight. If the weight of the patient is 132 lb, and the elimination rate constant is 0.33 hour 1, what is the total clearance of gentamicin ... 

Gentamicin, as with other aminoglycosides, is excreted through the kidney, and in renal impairment there is the risk of accumulation. Consequently doses are reduced and dosing interval increased in patients with renal impairment. 

The adult intravenous dose of gentamicin is 2 mg/kg every 8 hours. How many milligrams will a 65 kg patient receive daily ... 

Gentamicin is an aminoglycoside. All aminoglycosides tend to be nephrotoxic and ototoxic. The dose must be reduced and serum concentrations must be monitored in patients with impaired renal function. Concomitant administration of aminoglycosides and other nephrotoxic drugs, such as certain diuretics, ciclosporin, teicoplanin and vancomycin should be avoided. 

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