Gentamicin (Code ATH S01AA11)
When ATH:
S01AA11
Characteristic.
Bactericidal broad-spectrum antibiotic of the aminoglycoside. Gentamicin sulfate is a white powder or porous mass with kremovatam white, hygroscopic. Easily soluble in water, practically insoluble in alcohol.
Pharmacological action.
Broad-spectrum antibacterial.
Application.
For parenteral administration,: bacterial infection, caused by susceptible microorganisms: infections of the upper and lower respiratory tract (incl. bronchitis, pneumonia, empyema), complicated urogenital infections (incl. pyelonephritis, cystitis, uretrit, prostatitis, endometritis), bone and joint infections (incl. osteomyelitis), infections of skin and soft tissue, abdominal infections (peritonitis, pelvioperitonit), CNS infections (incl. meningitis), gonorrhea, sepsis, wound infection, burn infection, otitis.
For outdoor use: bacterial infections of the skin and soft tissues, due to the sensitive microflora: pyoderma (incl. gangrenous), Superficial folliculitis, furunculosis, sycosis, paronixija. Infected: Dermatitis (incl. contact, and eczematous seborrheic), ulcers (incl. varicose), wounds (incl. Surgical, vyalozazhivayuschie), burns (incl. plants), insect bites, skin abscesses and cysts, "Vulgar" eels; secondary bacterial infection of fungal and viral infections of the skin.
Eye drops: bacterial eye infections, due to the sensitive microflora: .Aloe, blefarokonъyunktyvyt, Bacterial dacryocystitis, conjunctivitis, keratit, keratokonъyunktyvyt, meybomit (barley), episcleritis, scleritis, helcoma, iridocyclitis.
Contraindications.
Hypersensitivity (incl. other aminoglycosides history).
For systemic use: severe renal failure with azotemia and uremia, azotemia (the residual nitrogen in the blood is higher 150 mg%), neuritis of the auditory nerve, diseases of the auditory and vestibular, myasthenia.
Restrictions apply.
For systemic use: myasthenia, parkinsonizm, botulism (aminoglycosides can cause a violation of neuromuscular transmission, which leads to a further weakening of the skeletal muscles), degidratatsiya, renal failure, the neonatal period, premature babies, advanced age.
For outdoor use: If necessary, the use of large skin surfaces — neuritis of the auditory nerve, myasthenia, parkinsonizm, botulism, renal failure (incl. severe chronic renal failure with azotemia and uremia), newborn and premature babies (underdeveloped renal function, that may increase T1/2 and the manifestation of the toxic effect), advanced age.
Pregnancy and breast-feeding.
When pregnancy is possible only for health reasons (adequate and well-controlled studies in humans have not held. There are reports, that other aminoglycosides leads to a deaf fetus). At the time of treatment must stop breastfeeding (It passes into breast milk).
Side effects.
Systemic effects
From the nervous system and sensory organs: ataxia, clonus, paraesthesia, benumbed sensation, seizures, headache, drowsiness, violation of neuromuscular transmission, ototoxicity-tinnitus, hearing loss, vestibular and labyrinth disorders, incl. dizziness, vertigo, irreversible deafness; children — psychosis.
Cardio-vascular system and blood (hematopoiesis, hemostasis): anemia, leukopenia, granulocytopenia, thrombocytopenia.
From the digestive tract: nausea, vomiting, increase in liver transaminases, giperʙiliruʙinemija.
With the genitourinary system: nephrotoxicity (oligurija, proteinuria, mikrogematuriâ); in rare cases, kidney tubular necrosis.
Allergic reactions: skin rash, itch, fever, angioedema, eozinofilija.
Other: fever, development of superinfection; children-hypocalcemia, kaliopenia, gipomagniemiya; reactions at the injection is soreness, periphlebitis and phlebitis (at / in the introduction).
When applied topically: allergic reactions: local — skin rashes, itch, dermahemia, burning sensation; rare generalized-fever, angioedema, eozinofilija. When a large suction surfaces may develop systemic effects.
Eye drops: burning sensation after application, burning pain in the eye, tingling sensation in the eyes, fog, allergic reactions (itch, redness and swelling of the conjunctiva).
Cooperation.
Incompatible with other GTR- and nephrotoxic agents. Antibiotics penicillin (ampicillin, karbenicillin, benzilpenicillin), cephalosporins enhance antimicrobial action (mutually) by expanding the range of activity. Loop diuretics increase the GRT- and nephrotoxicity (reduction in tubular secretion of gentamicin), muscle relaxants is the probability of respiratory paralysis. Pharmaceutical incompatible (can not be mixed in the same syringe) with other agents (incl. other aminoglycosides, amphotericin B, geparinom, Ampicillin, benzilpenicillinom, kloksacillinom, karbenicillinom, capreomycin).
Overdose.
Symptoms: decrease neuromuscular (respiratory arrest).
Treatment: adult I / administered anticholinesterase drugs (Proserinum), as well as calcium supplements (5-10 Ml 10% solution of calcium chloride, 5-10 Ml 10% solution of calcium gluconate). Before the introduction of pre-neostigmine in / atropine at a dose of 0.5-0.7 mg, expect increased heart rate and 1.5-2 m introduced in / 1,5 mg (3 ml 0,05% solution) Prozerina. If the effect of this dose was insufficient, re-enter the same dose of neostigmine (the appearance of bradycardia make additional injection of atropine). Children are calcium supplements. In severe cases, respiratory depression requires mechanical ventilation. It may be displayed by hemodialysis (more effective) and peritoneal dyalyza.
Dosing and Administration.
/ M, I /, locally, subkonъyunktyvalno. The dose is determined individually. When injecting the usual daily dose for diseases of moderate to adults with normal renal function is identical the on/in and/m introduction- 3 mg / kg / day, the frequency is 2-3 times a day; with heavy infections is to 5 mg / kg (the maximum daily dose) 3-4 reception. Average duration of treatment is 7-10 days. B / injection is carried out during 2-3 days, then move on to the / m introduction. If urinary tract infections daily dose for adults and children over 14 years is 0.8-1.2 mg/kg.
Young children prescribed only for health in severe infections. The maximum daily dose for children of all ages — 5 mg / kg.
Patients with impaired renal excretory function and elderly patients, and in severe burn patients to adequately select the dosing regimen is required to determine the concentration of gentamicin in the plasma. In severe infections recommended the appointment of smaller individual doses with greater magnification. The dosage should be adjusted so, to the value of Cmax does not exceed 12 ug / ml (reducing the risk of nephrotoxicity, th- and neurotoxicity). When edema, asci, Obesity is determined by the dose of the "ideal" or "dry" body weight. In violation of the kidney and the kidney recommended doses for adults after the session is 1-1 7, mg/kg (depending on the severity of the infection), children-2-2, 5 mg/kg.
Outwardly, a thin layer of the ointment applied to the affected area 3-4 times a day. If necessary, apply a bandage.
Sponge topical implanted into festering wounds after surgical rehabilitation.
Subkonъyunktyvalno, instill 1-2 drops 3-4 times daily.
Precautions.
During treatment should determine the concentration of drug in the serum (to prevent the appointment of the low / inefficient doses or, conversely, overdosing). Gentamicin concentration in the blood must not exceed 8 ug / ml.
For parenteral administration of gentamicin should be afraid of muscle relaxation due to violation of neuromuscular conduction.
Patients with infectious and inflammatory diseases of the urinary tract is recommended to take an increased amount of fluid. The likelihood of nephrotoxicity was higher in patients with impaired renal function, and when given in high doses or for a long time, so regularly (1 or 2 times a week, and in patients, receiving high doses or in treatment more 10 days daily) should monitor kidney function. To prevent the development of hearing loss should regularly (1 or 2 times a week) to conduct research to determine the vestibular function of hearing loss at high frequencies (when poor audiometric test dose reduce or stop treatment).
The treatment can develop resistance of microorganisms. In such cases, stop the drug and prescribe treatment based on antibiotikogrammy.
