Patients treated with aminoglycosides should be under close clinical observation because of the potential toxicity associated with their use.
As with other aminoglycosides, gentamicin sulfate is potentially nephrotoxic. The risk of nephrotoxicity is greater in patients with impaired renal function and in those who receive high dosage or prolonged therapy.
Neurotoxicity manifested by ototoxicity, both vestibular and auditory, can occur in patients treated with gentamicin sulfate primarily in those with pre-existing renal damage and in patients with normal renal function treated with higher doses and/or for longer periods than recommended. Aminoglycoside-induced ototoxicity is usually irreversible. Other manifestations of neurotoxicity may include numbness, skin tingling, muscle twitching and convulsions.
Renal and eighth cranial nerve function should be closely monitored, especially in patients with known or suspected reduced renal function at onset of therapy and also in those whose renal function is initially normal but who develop signs of renal dysfunction during therapy. Urine should be examined for decreased specific gravity, increased excretion of protein, and the presence of cells or casts. Blood urea nitrogen, serum creatinine, or creatinine clearance should be determined periodically. When feasible, it is recommended that serial audiograms be obtained in patients old enough to be tested, particularly high-risk patients. Evidence of ototoxicity (dizziness, vertigo, tinnitus, roaring in the ears or hearing loss) or nephrotoxicity requires dosage adjustment or discontinuance of the drug. As with the other aminoglycosides, on rare occasions changes in renal and eighth cranial nerve function may not become manifest until soon after completion of therapy.
Serum concentrations of aminoglycosides should be monitored when feasible to assure adequate levels and to avoid potentially toxic levels. When monitoring gentamicin peak concentrations, dosage should be adjusted so that prolonged levels above 12 mcg/mL are avoided. When monitoring gentamicin trough concentrations, dosage should be adjusted so that levels above 2 mcg/mL are avoided. Excessive peak and/or trough serum concentrations of aminoglycosides may increase the risk of renal and eighth cranial nerve toxicity. In the event of overdose or toxic reactions, hemodialysis may aid in the removal of gentamicin from the blood, especially if renal function is, or becomes, compromised. The rate of removal of gentamicin is considerably lower by peritoneal dialysis than it is by hemodialysis.
Concurrent and/or sequential systemic or topical use of other potentially neurotoxic and/or nephrotoxic drugs, such as cisplatin, cephaloridine, kanamycin, amikacin, neomycin, polymyxin B, colistin, paromomycin, streptomycin, tobramycin, vancomycin, and viomycin, should be avoided.
Other factors which may increase patient risk to toxicity are advanced age and dehydration.
The concurrent use of gentamicin with potent diuretics, such as ethacrynic acid or furosemide, should be avoided, since certain diuretics by themselves may cause ototoxicity. In addition, when administered intravenously, diuretics may enhance aminoglycoside toxicity by altering the antibiotic concentration in serum and tissue.
Aminoglycosides can cause fetal harm when administered to a pregnant woman (see WARNINGS).
in 0.9% Sodium Chloride Injection
Gentamicin Sulfate in 0.9% Sodium Chloride Injections are sterile, nonpyrogenic solutions of gentamicin sulfate in 0.9% sodium chloride injection. They are administered by the intravenous route as antibiotic infusions. They are premixed and require no further dilution. Each milliliter (mL) of the 50 mL size contains gentamicin sulfate equivalent to 1.2, or 1.6 mg gentamicin base with Sodium Chloride USP 9 mg in Water for Injection USP. Each milliliter (mL) of the 100 mL size contains gentamicin sulfate equivalent to 0.6, 0.8, or 1.0 mg gentamicin base with Sodium Chloride USP 9 mg in Water for Injection USP. Gentamicin Sulfate in 0.9% Sodium Chloride Injections have a calculated osmolarity of 290 mOsmol/liter; pH: 4.0 (3.0–5.5). May contain Sulfuric Acid NF and/or Sodium Hydroxide NF for pH adjustment. The solutions contain no bacteriostat, antimicrobial agent (except gentamicin) or buffer and are intended only for use as a single-dose injection. When smaller doses are required the unused portion should be discarded. Gentamicin is classified as a aminoglycoside antibiotic and is derived from Micromonospora purpurea, an actinomycete.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Gentamicin Sulfate in 0.9% Sodium Chloride Injection and other antibacterial drugs, Gentamicin Sulfate in 0.9% Sodium Chloride Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Gentamicin Sulfate in 0.9% Sodium Chloride Injection is indicated in the treatment of serious infections caused by susceptible strains of the following microorganisms: Pseudomonas aeruginosa, Proteus species (indole-positive and indole-negative), Escherichia coli, Klebsiella - Enterobacter - Serratia species, Citrobacter species, and Staphylococcus species (coagulase-positive and coagulase-negative).
Clinical studies have shown gentamicin sulfate to be effective in bacterial neonatal sepsis; bacterial septicemia, and serious bacterial infections of the central nervous system (meningitis), urinary tract, respiratory tract, gastrointestinal tract (including peritonitis), skin, bone and soft tissue (including burns).
Aminoglycosides, including gentamicin, are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are susceptible to these antibiotics and are not susceptible to antibiotics having less potential for toxicity.
Specimens for bacterial culture should be obtained to isolate and identify causative organisms and to determine their susceptibility to gentamicin.
Gentamicin may be considered as initial therapy in suspected or confirmed gram-negative infections, and therapy may be instituted before obtaining results of susceptibility testing. The decision to continue therapy with this drug should be based on the results of susceptibility tests, the severity of the infection, and the important additional concepts contained in the boxed WARNINGS. If the causative organisms are resistant to gentamicin, other appropriate therapy should be instituted.
In serious infections when the causative organisms are unknown, gentamicin may be administered as initial therapy in conjunction with a penicillin-type or cephalosporin-type drug before obtaining results of susceptibility testing. If anaerobic organisms are suspected as etiologic agents, consideration should be given to using other suitable antimicrobial therapy in conjunction with gentamicin. Following identification of the organism and its susceptibility, appropriate antibiotic therapy should then be continued.
Gentamicin has been used effectively in combination with carbenicillin for the treatment of life-threatening infections caused by Pseudomonas aeruginosa. It has also been found effective when used in conjunction with a penicillin-type drug for the treatment of endocarditis caused by group D streptococci.
Gentamicin has also been shown to be effective in the treatment of serious staphylococcal infections. While not the antibiotic of first choice, gentamicin may be considered when penicillins or other less potentially toxic drugs are contraindicated and bacterial susceptibility tests and clinical judgement indicate its use. It may also be considered in mixed infections caused by susceptible strains of staphylococci and gram-negative organisms.
In the neonate with suspected bacterial sepsis or staphylococcal pneumonia, a penicillin-type drug is also usually indicated as concomitant therapy with gentamicin.
Published Studies Related to Gentamicin Injection
Intratympanic Treatment of Intractable Unilateral Meniere Disease: Gentamicin or Dexamethasone? A Randomized Controlled Trial. [2011.11.18]
Objective. To determine the efficacy and safety of low-dose intratympanic gentamicin (ITG) compared with intratympanic dexamethasone (ITD) in patients with intractable unilateral Meniere disease (MD).Study Design.ITD offers poorer vertigo control rate, and hearing preservation is achieved only in cases with no vertigo recurrences.
Effects of intracameral triamcinolone and gentamicin injections following cataract surgery. [2011.07]
CONCLUSION: Intracameral injections of triamcinolone acetonide and gentamicin appear to be a promising treatment option for the control of post-operative inflammation following cataract surgery.
Comparison of the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks versus streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis: a randomized clinical trial. [2010.05]
OBJECTIVES: To compare the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks with streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis... CONCLUSIONS: The results show that the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks is not superior to that of streptomycin for 2 weeks plus doxycycline for 45 days.
Daily compared with 8-hour gentamicin for the treatment of intrapartum chorioamnionitis: a randomized controlled trial. [2010.02]
OBJECTIVE: To assess whether daily gentamicin is as effective as 8-hour gentamicin for the treatment of intrapartum chorioamnionitis... CONCLUSION: Daily and 8-hour gentamicin appear equally effective for the treatment of intrapartum chorioamnionitis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00185991. LEVEL OF EVIDENCE: I.
Daily compared with 8-hour gentamicin for the treatment of intrapartum
chorioamnionitis: a randomized controlled trial. 
gentamicin for the treatment of intrapartum chorioamnionitis... CONCLUSION: Daily and 8-hour gentamicin appear equally effective for the
Clinical Trials Related to Gentamicin Injection
Topical Gentamicin Cream Versus Alternating Gentamicin and Mupirocin Cream in Peritoneal Dialysis [Not yet recruiting]
Catheter-related infection, namely exit site infection and peritonitis, is the commonest
complication of peritoneal dialysis. This complication causes significant morbidity and
mortality in patients requiring peritoneal dialysis. Topical application of mupirocin 2%
cream was first proven to be effective in reduction of staphylococcus-related catheter
infection in 1990s. Subsequent randomized trial published in 2005 showed that gentamicin
cream was superior to mupirocin 2% cream in reducing both Gram's positive and Gram's
negative related catheter infection. However, a retrospective report published in 2007 puts
the use of prophylactic antibiotic cream into a question. It reported an emergency of
non-tuberculous mycobacterial infection in a dialysis center in Hong Kong after practising
prophylactic application of gentamicin cream at the catheter exit site. The following
prospective, randomized and open-label study aims to find out an optimal regimen of topical
antibiotic prophylaxis in patients requiring peritoneal dialysis.
Local Gentamicin Application to Reduce Postoperative Infection Rate [Recruiting]
The majority of elderly patients with a displaced fracture of the proximal femur are now
treated with a hemiarthroplasty. Prosthetic joint infection is a devastating complication,
and the infection rate is high in this group of elderly patients. Local application of
gentamicin produces high antibiotic concentrations in the wound. The aim of this study is to
determine whether locally administered collagen-gentamicin in the joint perioperatively in
addition to routine IV prophylaxis with beta-lactam antibiotics can reduce the early
postoperative infection rate (< 4 weeks postoperative)after hemiarthroplasty in proximal
Pharmacokinetics, Safety, and Efficacy Trial of WR 279,396 (Paromomycin + Gentamicin Topical Cream) and Paromomycin Topical Cream for the Treatment of Cutaneous Leishmaniasis in Panama [Recruiting]
The objectives of the study are to evaluate the pharmacokinetics (PK), safety, and efficacy
of WR 279,396 (Paromomycin + Gentamicin Topical Cream) and Paromomycin Topical Cream in
subjects with cutaneous leishmaniasis (CL).
Safety, Efficacy, and PK of Topical Paromomycin/Gentamicin Cream for Treatment of Cutaneous Leishmaniasis [Recruiting]
The objectives of the study are to evaluate the safety, pharmacokinetics (PK), and efficacy
of open label treatment with WR 279,396 (Topical Paromomycin/Gentamicin Cream)in subjects
with cutaneous leishmaniasis (CL).
Collagen-Gentamicin Implant in the Treatment of Contaminated Surgical Abdominal Wounds [Recruiting]
The investigators' hypothesis is that placement of CollatampG in the subcutaneous layer of
contaminated abdominal wounds is effective prophylaxis for superficial surgical site
infection (SSI). CollatampG is composed of highly purified type 1 collagen obtained from
bovine tendon, which acts as a vehicle for the aminoglycoside antibiotic, gentamicin. This
implant provides a high concentration of local gentamicin at the surgical wound to decrease
the local microorganism load. It has been shown that if a surgical site is contaminated with
> 10 to the power of 5 microorganisms per gram of tissue, the risk of infection is markedly
increased. When a gastrointestinal organ is the source of pathogens, gram-negative bacilli
(e. g., E. coli) are typical isolates, which are susceptible to gentamicin. Therefore, a high
local concentration of gentamicin at the contaminated surgical wound provided by the
CollatampG implant may prevent the local bacterial load from reaching levels high enough to
cause a clinical infection.
Page last updated: 2013-02-10