Gentamicin

Indications
 Intramuscular
Susceptible infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Biliary tract infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Brucellosis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Cat scratch disease
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Cystic fibrosis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Endocarditis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Endometritis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Gastroenteritis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Granuloma inguinale
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Listeriosis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Meningitis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Otitis externa
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Pelvic inflammatory disease
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Peritonitis
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Plague
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Pneumonia
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Septicaemia
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Skin infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Urinary tract infections
Adult: 3-5 mg/kg/day, given in divided doses every 8 hr for 7-10 days.
Child: ≤2 wk: 3 mg/kg every 12 hr; 2 wk-12 yr: 2 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Intramuscular
Prophylaxis of surgical infections
Adult: 120 mg before induction of anaesthesia, in combination with penicillin, vancomycin or teicoplanin .
Renal impairment: Haemodialysis: Administer dose after dialysis session and monitor levels.
CrCl (ml/min)Dosage Recommendation
≥60Administer every 8 hr.
40-60Administer every 12 hr.
20-40Administer every 24 hr.
<20Loading dose, monitor levels.

Ophthalmic
Superficial ophthalmic infections
Adult: Instil 1-2 drops of a 0.3% soln into the infected eye/s every 4 hr or up to 2 drops every hr in severe infections. Alternatively, apply a small amount of 0.3% oint bid-tid into the affected eye.
Topical/Cutaneous
Bacterial skin infections
Adult: As a 0.1% cream; Apply to the affected area 3-4 times daily.

Special Populations: Renal impairment: Increase the interval between doses keeping serum creatinine levels as a guide. In patients on dialysis an 8 hr dialysis reduces serum levels of gentamicin by 50%. At the end of each session give 1-1.7 mg/kg for adults and 2 mg/kg for children. For IV use, each dose of gentamicin diluted with 50-100 mL of IV fluids given over 20 min. Duration 7-10 days.
Contraindications
 History of hypersensitivity to aminoglycoside; pregnancy; hepatic impairment, perforated ear drum.
Warnings / Precautions
 Concurrent use of neuromuscular blocking agents; myasthenia gravis, parkinsonism; conditions predisposing to ototoxicity and nephrotoxicity; lactation. Monitor plasma concentrations of gentamicin in patients receiving high doses or prolonged courses, in infants, elderly, patients with renal impairment, cystic fibrosis or significant obesity. Monitor auditory and renal functions.
Adverse Reactions
 Dizziness or vertigo; acute renal failure, interstitial nephritis, acute tubular necrosis; electrolyte imbalances; transient elevation of serum bilirubin and aminotransferases; purpura; nausea, vomiting; convulsions, mental depression, hallucinations. Atrophy or rat necrosis at inj sites.
Potentially Fatal: Nephrotoxicity, ototoxicity and neuromuscular blockade (may unmask or aggravate myasthaenia gravis).
Overdose Reactions
 Haemodialysis may be useful in the removal of gentamicin from the blood, and is important if renal function is, or becomes compromised. Rate of removal is lower by peritoneal dialysis compared to haemodialysis.
Drug Interactions
 Synergistic with ampicillin, benzylpenicillin and other β-lactam antibiotics. Increased risk of severe respiratory depression when used concurrently with anaesthetics or opioids. May reduce renal clearance of zalcitabine and induce hypocalcaemia when used with biphosphonates. Not to be used with agalsidase alfa or beta as it may inhibit α-galactosidase activity.
Potentially Fatal: Increased incidence of ototoxicity when combined with ethacrynic acid and furosemide. Cephalosporins, ciclosporin, cisplatin, vancomycin, hydrocortisone and indometacin potentiate nephrotoxicity. Potentiates neuromuscular blocking agents.
See Below for More gentamicin Drug Interactions
Mechanism of Actions
 Gentamicin is an aminoglycoside that binds to 30s and 50s ribosomal subunits of susceptible bacteria disrupting protein synthesis, thus rendering the bacterial cell membrane defective.
Absorption: Poorly absorbed from the GI tract (oral); rapid (IM); systemic absorption from denuded skin and burns (topical) and from wounds, body cavities, joints (instillation, irrigation).
Distribution: Diffuse mainly into the extracellular fluids; but only small amounts enter the CSF even when the meninges are inflamed. Poorly diffused (Ophthalmic), readily diffused (perilymph of the inner ear). Crosses the placenta and enters the breast milk. Accumulates mainly in the kidneys.
Excretion: Via the urine by glomerular filtration (virtually unchanged); 2-3 hr (elimination half-life).
Storage Conditions
 Intramuscular: Store at 15-30°C. Ophthalmic: Store at 2-30°C. Topical/Cutaneous: Store at 2-30°C.
ATC Classification
 D06AX07 - gentamicin ; Belongs to the class of other topical antibiotics used in the treatment of dermatological diseases.
J01GB03 - gentamicin ; Belongs to the class of other aminoglycosides. Used in the systemic treatment of infections.
S01AA11 - gentamicin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
S02AA14 - gentamicin ; Belongs to the class of antiinfectives used in the treatment of ear infections.
S03AA06 - gentamicin ; Belongs to the class of antiinfectives used in ophthalmologic and otologic preparations.
Storage
 Intramuscular: Store at 15-30°C. Ophthalmic: Store at 2-30°C. Topical/Cutaneous: Store at 2-30°C.
Available As
  • Gentamicin Sulphate
  • Gentamicin Sulphate 0.01%
  • Gentamicin 0.01% w/w
  • Gentamicin 0.020% w/w
  • Gentamicin 0.03%
  • Gentamicin Sulphate 0.03% w/v
  • Gentamicin 0.1 w/w
  • Gentamicin 0.1%
  • Gentamicin Sulphate 0.1%
  • Gentamicin 0.1% w/v
  • Gentamicin Sulphate 0.1% w/v
  • Gentamicin Sulphate 0.1% w/w
  • Gentamicin Sulpahte 0.1% w/w
  • Gentamicin Sulphate IP 0.1% w/w
  • Gentamicin 0.1% w/w
  • Gentamicin Sulphate 0.1%w/w
  • Gentamicin Sulphate 0.10%
  • Gentamicin 0.10%
  • Gentamicin Sulphate 0.10% w/w
  • Gentamicin 0.10% w/w
  • Gentamicin Sulphate IP 0.10% w/w
  • Gentamicin 0.2% w/w
  • Gentamicin Sulphate 0.2% w/w
  • Gentamicin 0.20% w/w
  • Gentamicin 0.200% w/w
  • Gentamicin Sulphate IP 0.3 %
  • Gentamicin 0.3 mg
  • Gentamicin Sulphate IP 0.3%
  • Gentamicin Sulphate 0.3%
  • Gentamicin 0.3%
  • Gentamicin Sulpahte IP 0.3% w/v
  • Gentamicin 0.3% w/v
  • Gentamicin Sulphate IP 0.3% w/v
  • Gentamicin Sulpahte 0.3% w/v
  • Gentamicin Sulphate 0.3% w/v
  • Gentamicin 0.3% w/w
  • Gentamicin Sulphate 0.3% w/w
  • Gentamicin Sulphate 0.3%w/v
  • Gentamicin Sulphate IP 0.300% w/w
  • Gentamicin 0.5%
  • Gentamicin 1 mg
  • Gentamicin Sulphate 1 mg
  • Gentamicin 1% w/w
  • Gentamicin Sulphate 1% w/w
  • Gentamicin Sulphate 10 mg
  • Gentamicin 10 mg
  • Gentamicin Sulphate 20 mg
  • Gentamicin Sulphate IP 20 mg
  • Gentamicin 20 mg
  • Gentamicin Sulphate 3 mg
  • Gentamicin Sulphate IP 3 mg
  • Gentamicin Sulpahte 3%
  • Gentamicin 3000 iu
  • Gentamicin Sulphate 40 mg
  • Gentamicin 40 mg
  • Gentamicin Sulphate 60 mg
  • Gentamicin Sulpahte 80 mg
  • Gentamicin Sulphate 80 mg
  • Gentamicin 80 mg
  • Gentamicin 800 mg

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