Gentamicin

Our hospital antibiotic policy recommends the use of once-daily gentamicin for complicated urinary tract infection, life-threatening infection, bone and joint infection and intra-abdominal sepsis. We recommend starting with 5 mg kg bodyweight of gentamicin if the creatinine clearance is 30 mL min with subsequent dosage adjustment according to serum gentamicin levels. We do not recommend once daily dosing if there is moderate or severe renal impairment creatinine clearance 30 mL min or creatinine plasma concentration 200 mmol L ; . It has been suggested by Freeman et al.1 that 57 mg kg bodyweight of gentamicin once daily is acceptable but that the optimum dosage has not been clearly determined. The 7 mg kg regimen proposed by Nicolau et al.4 involves complicated dosing schedules 36-hourly, 48-hourly dosing ; based on the patient's creatinine clearance and requires the calculation of dosages based on actual body weight or ideal body weight if the patient is morbidly obese. We considered these estimations to be a potential cause of dosing error on our general wards. The possibility of endotoxin-like reactions with higher doses was deemed to be a further risk which could be minimized by using the lower dosing schedule. According to our policy, the first pre-dose level should be taken before the second dose is administered. Doses should not be withheld while awaiting the result. If the first pre-dose level is 1 mg L, we suggest measuring levels twice weekly thereafter. If the level is 1 mg L but 2 mg L, the dose should be reduced to 4 mg kg and the level repeated before the third dose. Twice weekly levels can then be instituted if this brings the level to 1 mg L. For patients with moderate to severe renal impairment or persistently high pre-dose levels, advice should be sought from a pharmacist or microbiologist. Prescribing and monitoring information was gathered prospectively on daily ward rounds. Data collected included dose prescribed, date and time of administration, interval between doses, duration of therapy, timing of pre-dose levels, serum urea, creatinine and gentamicin levels. A re-audit was carried out on a further 20 patients 1 year later and 7 months after the hospital-wide introduction of a gentamicin monitoring form. A similar range of infections was represented. The form comprised a prescription and administration chart for daily prescribing of gentamicin with additional spaces to request and enter therapeutic drug monitoring levels. On the reverse was an algorithm outlining the estimation of creatinine clearance using body weight and serum creatinine level, calculation of the starting dose, measurement of serum levels and actions to take in response to reported levels. Table 1. Results of audits First audit no. of patients ; Total no. of patients in audit Gentamicin monitoring form used throughout Initial dose correct Dosing interval correct Renal function monitored Initial serum gentamicin level correctly timed Subsequent serum gentamicin levels checked appropriately No doses omitted inappropriately Dose adjusted correctly if required Duration of gentamicin therapy appropriate Fully compliant with policy 20 0 13 Second audit no. of patients ; 20 18!

RESULTS The pharmacokinetics of amikacin and gentamicin in rabbits with sterile peritonitis is shown in Fig. 1. Six animals were given each antibiotic, and each isobar represents plus or minus the standard error of the mean. For both antibiotics, the levels in the peritoneal fluid exceeded those in the serum by 1 h, and thereafter remained above simultaneous serum levels. Figure 2 shows that high doses of penicillin are rapidly excreted: by h 3 after injection, most penicillin had been cleared from the serum, whereas the peritoneal fluid concentrations remained high. Figure 3 displays the peritoneal fluid concentration of each antibiotic as a percentage of the peak serum level for that antibiotic. Amikacin proved most effective in entering the peritoneal exudate, with levels reaching 71.2% + 12.7 standard error ; of peak serum levels; gentamicin reached 37.1% 2.7, and penicillin reached 23.2% + 4.5.

Canadian Gentamicin Antimicrobial therapy In infants less than 3 months: s For definite neonatal meningitis, cefotaxime or ceftriaxone ; alone or with ampicillin is the preferred treatment. If this is not available ampicillin plus gentamicin or chloramphenicol may be used. s Suspected cases should be treated as sepsis with ampicillin or penicillin plus aminoglycoside until meningitis is confirmed. In children 3 months and over: s Initial treatment of meningitis with chloramphenicol plus ampicillin or penicillin is appropriate if there is no significant penicillin resistance. Penicillin-resistant pneumococci, however, are now found in many parts of the world with increasing frequency, and this treatment is unsatisfactory for meningitis caused by penicillin-resistant pneumococci, even at intermediate levels of resistance. Where resistance data for pneumococcal meningitis is not available, an effort should be made to collect such data. s In areas where penicillin-resistant pneumococci are common, initial therapy should be with cefotaxime or ceftriaxone. s Suspected cases of bacterial meningitis should be treated with the recommended antimicrobial treatment and the decision to continue treatment should be taken based on the CSF examination findings, if available. The role of dexamethasone s There is insufficient evidence to support recommendations for the routine use of dexamethasone for all children with bacterial meningitis treated with penicillin and chloramphenicol in developing countries. s The role of steroids in bacterial meningitis cases treated with cephalosporins cefotaxime or ceftriaxone ; in developing countries should be further studied. Fluid therapy in meningitis s The current recommendation to restrict fluids in children with bacterial meningitis is based on the presumption that the raised ADH levels are inappropriate and harmful. s There is no clear evidence that fluid restriction is beneficial. Animal studies of experimental meningitis and a human study from India suggest that fluid restriction may be harmful but the evidence is inconclusive. s Fluid restriction in the first 48 hours of meningitis management should be compared with full maintenance fluid in randomized clinical trials. Anaerobic bacteria as well as gram-positive bacteria 18 ; . We report here the results of a prospective randomized study in which imipenem-cilastatin hereafter referred to as imipenem ; was compared with the combination of gentamicin plus either cefuroxime or cephalothin for febrile neutropenic patients receiving either no prophylaxis or ciprofloxacin for infection prevention and gentian. One of the latest Ichthyophonus hofen-induced mortalities of herring in the western North Atlantic in the Gulf of St. Lawrence ; started in mid-May 1954 and reached its peak in June, then continued at about the same level throughout July and apparently ceased in August Tibbo & Graham 1963 ; . Sindermann 1958 ; estimated that at least 50% of the mature herring in the Gulf of St. Lawrence were destroyed during the period 1954 56. The maximum prevalence of the disease was 78 %, with a n average prevalence of 27 % in 1954 Sindermann 1958 ; , but there were also wide variations between samples and from year to year. In 1957 the prevalence dropped to 10 % Tibbo & Graham 1963 ; . In the Skagerrak-Kattegat area, however, the peak of mortality was seen during August-September 1991. This is different from that which was reported for the Gulf of St. Lawrence, the peak having occurred there in mid-May. In addition, the prevalence during the months following the mortality peak was lower in Swedish waters as compared with prevalence during the corresponding periods in the Gulf of St. Lawrence. These differences could have arisen because of the complex structure of the hernng stock in the Swedish area. The area supports the North Sea autumn spawning population at 2 levels, nursery and overwintering; moreover, it acts as a spawning site and nursery ground for the spring spawning population McKeown 1984, Anonymous 1991a, b ; . The area also acts as a migratory route between the Norwegian Deeps and the south-west Baltic for the spring spawning population. The Skagerrak is also considered to be a part of the feeding grounds for the spring spawning population. The dominant population of the region, however, is the spring spawning population Anonymous 1991a, b ; . The herring stocks of the Gulf of St. Lawrence are less complicated than those of the Skagerrak-Kattegat. Therefore, it is possible that one of the populations of the Skagerrak-Kattegat area has been highly infected with Ichthyophonus hoferi and that the presence of that stock in the area has caused the peak of prevalence and the consequent mortality. Our study suggests that there may be a relationship between the fluctuation of the prevalence of ichthyophonosis and the migration pattern of herring to and from the area. The spring spawners migrate from the south of the Baltic Sea and the Sound, throughout the Kattegat-Skagerrak, toward the north as early as May. The time of migration back to the SkagerrakKattegat, after having spent the summer in the Norwegian Deeps, varies from year to year, but it normally begins in late September Anonymous 1991a, b ; . Since the epizootic among the herring population occurred in August-September 1991, it is possible.

Gentamicin medicine Available as tetracycline and tetracycline hydrochloride; dosage expressed in terms of tetracycline hydrochloride. Pediatric Patients General Pediatric Dosage Oral: Children 8 years of age: 25 50 mg kg daily in 4 divided doses. Balantidiasis Oral: Children 8 years of age: 40 mg kg daily up to 2 divided doses given for 10 days. Brucellosis Oral: Children 8 years of age: 30 40 mg kg daily in 4 divided doses. Duration of treatment usually is 4 6 weeks; more prolonged treatment may be necessary for severe infections or when there are complications. If infection is severe or if endocarditis, meningitis, or osteomyelitis are present, administer IM streptomycin or gentamicin during the first 7 14 days of tetracycline therapy. Rifampin can be administered concomitantly with or without an aminoglycoside ; to decrease the risk of relapse. Dientamoeba fragilis Infection Oral: Children 8 years of age: 40 mg kg daily up to 2 divided doses given for 10 days. Malaria Treatment of Uncomplicated Chloroquine-resistant P. falciparum Malaria Oral: Children 8 years of age: 6.25 mg kg 4 times daily given for 7 days; used in conjunction with oral quinine sulfate 10 mg kg 3 times daily given for 3 days if infection was acquired in Africa or South America or for 7 days if acquired in Southeast Asia ; . Treatment of Uncomplicated P. vivax Malaria Oral: Children 8 years of age: 6.25 mg kg 4 times daily given for 7 days; used in conjunction with oral quinine sulfate 10 mg kg 3 times daily given for 3 days if infection was acquired in Africa or South America or for 7 days if acquired in Southeast Asia ; . In addition, a 14-day regimen of oral primaquine 0.6 mg kg once daily ; also may be indicated to provide a radical cure and prevent delayed attacks or relapse of P. vivax malaria. Treatment of Severe P. falciparum Malaria Oral: Children 8 years of age: 6.25 mg kg 4 times daily given for 7 days; used in conjunction with IV quinidine gluconate followed by oral quinine sulfate ; given for a total duration of 3 7 days. If an IV tetracycline is necessary initially, use IV doxycycline until oral therapy can be tolerated. Plague Treatment of Pneumonic Plague Oral: Children 8 years of age: 25 50 mg kg daily in 4 divided doses given for 10 14 days. Prompt initiation of treatment within 18 24 hours of symptom onset ; is essential. A parenteral regimen e.g., IM streptomycin, IM or IV gentamicin, IV doxycycline ; is preferred for initial treatment; an oral regimen may be substituted when the patient's condition improves or if a parenteral regimen is unavailable and ginger. F EDOSEYEV, V N et al. ISOLDE Collaboration In: 1st Euroconference on Atomic Physics at Accelerators : Laser Spectroscopy and Applications -- APAC '99, Mainz - Budenheim, Germany, 19 - 24 Sep 1999 Ed. by Schweikhard, L and Kluge, H J . Hyperfine Interact. : 127 2000 ; no.1-4 pp.409-416. Galactosum . 1649 Gallamine triethiodide . 1649 Gallamini triethiodidum . 1649 Gallii 67Ga ; citratis solutio iniectabilis . 826 Gallium 67Ga ; citrate injection . 826 Gargles. 612 Garlic for homoeopathic preparations . 897 Garlic powder. 1651 Gas chromatography 2.2.28. ; . 42 Gas detector tubes 2.1.6. ; .19 Gases, carbon dioxide in 2.5.24. ; . 134 Gases, carbon monoxide in 2.5.25. ; . 134 Gases, nitrogen monoxide and nitrogen dioxide in 2.5.26. ; . 135 Gases, nitrous oxide in 2.5.35. ; .141 Gases, oxygen in 2.5.27. ; . 136 Gases, water in 2.5.28. ; . 136 Gas-gangrene antitoxin, mixed . 802 Gas-gangrene antitoxin novyi ; . 802 Gas-gangrene antitoxin perfringens ; . 803 Gas-gangrene antitoxin septicum ; . 804 Gastro-resistant capsules .5.2-3136 Gastro-resistant granules. 5.2-3141 Gastro-resistant tablets .5.2-3152 Gelatin . 1651 Gelatina . 1651 Gels. 625 Gels for injections . 5.2-3146 General chapters 1.3. ; .6 General notices 1. ; .5 General statements 1.1. ; .5 General texts on sterility 5.1. ; . 445 General texts on vaccines 5.2. ; . 453 Gentamicini sulfas . 1653 Gentamicin sulphate. 1653 Gentianae radix . 1654 Gentianae tinctura. 1655 Gentian root . 1654 Gentian tincture . 1655 Ginger . 1656 Gingival solutions . 612 Ginkgo folium . 1657 Ginkgo leaf . 1657 Ginseng.5.1-2935 Ginseng radix.5.1-2935 Glass containers for pharmaceutical use 3.2.1. ; . 303 Glibenclamide . 1659 Glibenclamidum . 1659 Gliclazide. 1660 Gliclazidum. 1660 Glipizide . 1662 Glipizidum . 1662 Glossary dosage forms ; . 599 Glucagon . 1663 Glucagon, human. 1665 Glucagonum . 1663 Glucagonum humanum . 1665 Glucose, anhydrous . 1666 Glucose, liquid . 1667 Glucose, liquid, spray-dried. 1668 Glucose monohydrate . 1669 Glucosum anhydricum . 1666 Glucosum liquidum . 1667 Glucosum liquidum dispersione desiccatum. 1668 Glucosum monohydricum . 1669 Glutamic acid . 1670 Glutathione.5.1-2936 Glutathionum .5.1-2936 Glycerol . 1671 and ginkgo.

MATERIALS AND METHODS Organisms. One hundred and one fresh isolates of S. aureus were obtained from four Fargo community hospitals in 1978. All organisms were catalase, slide, and tube coagulase-positive, gram-positive cocci that formed clusters on gram stain and were susceptible to oxacillin and cephalothin by Kirby-Bauer disk diffusion tests 9, 23 ; . Twenty-eight strains were susceptible to penicillin G; the remainder were penicillinase producers by the method of Rosenblatt and Neumann 31 ; or Lee and Komarmy 22 ; . Antibiotics. Standard powders were provided by the manufacturers: sodium oxacillin and sodium methicillin Bristol Laboratories, Syracuse, N.Y. penicillin G, sodium cephalothin, and vancomycin hydrochloride Eli Lilly & Co., Indianapolis, Ind. and gentamicin sulfate Schering Corp., Bloomfield, N.J. ; . MIC MBC testing. MICs were determined in 1 ml Mueller-Hinton broth Difco Laboratories, Detroit, Mich. ; in 10-ml glass test tubes with log 5-cfu ml log-growth-phase inocula subcultured from the original isolation plates 1 ; . MIC endpoints were read as the lowest antimicrobial concentration producing a clear tube. All inocula were quantitated and averaged to log 5.7 cfu ml. Clear tubes were sampled after 24 h of incubation at 35C with a calibrated 0.01-ml loop and streaked on quadrants of a sheep blood agar plate. CFUs were counted after 18 to 24 incubation at 35C, and the MBC was read as the lowest antibiotic.