Otomax human equivalent
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Important risk factors are pre-existing renal impairment or a history of damage to the eighth cranial nerve in addition, the risk increases in proportion to the level of the total and daily dose or by association with potentially ototoxic substances. Hearing loss is manifested initially by diminution of high-tone acuity and is usually irreversible. Vestibular damage is the most common ototoxic reaction. Neuromuscular blockade and respiratory paralysis have been reported from administration of aminoglycosides to patients who have received curare-type muscle relaxants during anaesthesia.)ĭamage to the vestibulocochlear nerve (eighth cranial nerve), whereby both balance and hearing may be affected, is possible. Since gentamicin has neuromuscular blocking properties, particular caution should be exercised in patients with pre- existing neuromuscular diseases (e.g.) The most important risk factors are high total dose, long duration of therapy, raised serum level (high trough level) in addition, other potential risk factors are age, hypovolaemia and shock.Ĭlinical signs of renal damage are: proteinuria, cylindruria, haematuria, oliguria, raised creatinine and urea concentrations in serum.) Renal impairment such as restriction of glomerular filtration is observed in approximately 10% of patients treated with gentamicin and is usually reversible. The frequency or dose of administration should be reduced in patients with impaired renal function. In patients with advanced renal impairment or with pre-existing inner ear deafness, gentamicin should be used only if its use is considered essential by the physician. Serum concentration monitoring of gentamicin is recommended, especially in elderly, in newborns and in patients with impaired renal function.
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If administered by infusion, this should be over no longer than 20 minutes and in no greater volume of fluid than 100ml. Gentamicin when given intravenously should be injected directly into a vein or into the drip set tubing over no less than three minutes. The recommended dose and precautions for intramuscular and intravenous administration are identical. One hour concentrations of gentamicin should not exceed 10mg/l (but should reach 4mg/l), while the pre-dose trough concentration should be less than 2mg/l Assay of peak serum levels gives confirmation of adequacy of dosage and also serves to detect levels above 10mg/l, at which the possibility of ototoxicity should be considered. Trough levels are measured just prior to the next injectable. Peak levels of gentamicin occur approximately one hour after intramuscular injectable and intravenous injectable. If these dosage guides are used peak serum levels must be measured. Frequency of dosage in hours may also be approximated as serum creatine (mg%) x eight or in SI units, as serum creatine (μmol/l) divided by 11. The following table may be useful when treating adults. Nomograms are available for the calculation of the dose, which depends on the patient's age, weight, and renal function In impaired renal function, the recommended daily dose has to be decreased and adjusted to the renal function. Gentamicin is excreted by simple glomerular filtration. There is some evidence that elderly patients may be more susceptible to aminoglycoside toxicity whether secondary to previous eighth nerve impairment or borderline renal dysfunction.Īccordingly, therapy should be closely monitored by frequent determination of gentamicin serum levels, assessment of renal function and signs of toxicity. Due to the longer half-life, neonates are given the required daily dose in 1 single dose. The daily dose in neonates is 4-7 mg/kg body weight per day. The daily dose in infants after the first month of life is 4.5-7.5 mg/kg body weight per day as 1 single dose (preferred) or up to 2 single doses. The daily dose recommended in children (aged 1 year and above) and adolescents with normal renal function, is 3-6 mg/kg body weight per day as 1 single dose (preferred) or up to 2 single doses. Or, if renal function is not impaired, 160mg once daily may be used. Urinary tract infections: as 'systemic infections'. The total daily dose may be subsequently increased or decreased as clinically indicated. Serious infections: if renal function is not impaired, 5mg/kg daily in divided doses at six or eight hourly intervals. Systemic infections: if renal function is not impaired, 3-5 mg/kg/day in divided doses according to severity of infection, adjusting according to clinical response and body weight.