Changes for gentamicin
October 5, 2010
MAJOR changes in the way that
antibiotic gentamicin is used in
Australian hospitals have been
proposed by the authors of
Therapeutic Guidelines:Antibiotic.
Writing in the October issue of
NPS’ Australia Prescriber, the
Guidelines’ Expert Writing Group
(GEWP) says that many clinicians
are reluctant to prescribe
gentamicin because of its toxicity -
which has resulted in increasing
use of alternative drugs such as
broad-spectrum cepalosporins.
This in turn has been linked with
the increasing prevalence of drugresistant
organisms, with the
experts recommending “clear
distinctions between empirical and
directed therapy”.
For empirical therapy, the
recommended treatment duration
with gentamicin is now limited to a
maximum of 48 hours in all patients.
After this initial treatment,
ongoing therapy should be guided
by results but even if results are not
available by 72 hours the
gentamicin should be discontinued
and an alternative regimen used.
If a susceptible Gram-negative
organism is identified, gentamicin
should only be continued if the
patient has a particular “specific
and uncommon indication” for
directed therapy.
In these cases monitoring of
plasma concentrations is sessential,
and the GEWP is mandating the use
of “more accurate computerised
methods of monitoring” to
discourage long-term use of
gentamicin - meaning that the
guidelines will in future intentionally
omit the monitoring nomograms.
“Patients should be in a facility
that has access to a computerised
monitoring program and skilled
personnel to interpret the information.
“It is hoped that the changes will
lead to better patient care by
striking a practical balance
between the benefits of the breadth
of activity of gentamicin and its
rapid bactericidal activity, especially
in bloodstream infections, versus
the limitations of toxicity with
prolonged use,” the group said.
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