GENTHERAXINE

Gentamicin is a bactericidal aminoglycoside that was discovered and isolated from Micromonospora purpurea in 1963.

It is one of the most frequently prescribed aminoglycosides due to its spectrum of activity, low cost, and availability. 5, 8 Gentamicin is effective against both gram-positive and gram-negative organisms but is particularly useful for the treatment of severe gram-negative infections including those caused by Pseudomonas aeruginosa. 6, 10, 11 There is the added benefit of synergy when gentamicin is co-administered with other antibacterials such as beta-lactams.

This synergistic activity is not only important for the treatment of complex infections, but can also contribute to dose optimization and reduced adverse effects. 10, 11 Although gentamicin is well-established and may be used in a variety of clinical applications, it is also associated with severe adverse effects including nephrotoxicity and ototoxicity which may limit its use.

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Gentamicin is excreted primarily by the kidneys.

In patients with normal renal function, 70% or more of an initial gentamicin dose can be recovered in the urine within 24 hours.

Excretion of gentamicin is significantly reduced in patients with renal impairment.

One study assessing the pharmacokinetics of gentamicin in children and adults reported a mean half-life of 75 minutes after intravenous administration.

The mean half-life associated with intramuscular administration was about 29 minutes longer.

Fever and anemia may result in a shorter half-life although dose adjustments are not usually necessary. 2, 24 Severe burns are also associated with a shorter half-life and may result in lower gentamicin serum concentrations.

The renal clearance of gentamicin is comparable to individual creatinine clearance. 3, 24.

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As with other aminoglycosides, nephrotoxicity and ototoxicity are associated with gentamicin.

Signs of nephrotoxicity include an increase in plasma creatinine and urea, while signs of ototoxicity include issues with balance, nausea, tinnitus, and hearing loss.

It is important to note that aminoglycoside-induced nephrotoxicity is typically reversible, while ototoxicity is more likely to be permanent.

The risk of both toxicities increases with long-term gentamicin therapy.

Gentamicin is considered to be more vestibulotoxic than cochleotoxic compared to other aminoglycosides. 9, 4 Unfortunately, gentamicin-related ototoxicity does not correlate with cumulative dosing, peak and trough levels, or dosing schedule.

The unpredictability of ototoxicity supports close monitoring of the patient throughout treatment.

In cases of toxicity or overdose, the medication should be discontinued immediately; hemodialysis may be initiated to lower gentamicin serum concentrations.