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The possibility of these phenomena occurring in man should be considered if aminoglycosides are administered by any route to patients receiving anesthetics, or to patients receiving neuromuscular blocking agents, such as succinylcholine, tubocurarine, or decamethonium, or in patients receiving massive transfusions of citrate anticoagulated blood. While some variation is to be expected due to a number of variables such as age, body temperature, surface area and physiologic differences, the individual patient given the same dose tends to have similar levels in repeated determinations. The standardized procedure requires the use of standardized inoculum concentrations and paper disks impregnated with 10 mcg of gentamicin.Standardized susceptibility test procedures require the use of laboratory controls to monitor and ensure the accuracy and precision of supplies and reagents used in the assay, and the techniques of the individuals performing the test.To reduce the development of drug-resistant bacteria and maintain the effectiveness of gentamicin and other antibacterial drugs, gentamicin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. (See also section 4.8)Since gentamicin has neuromuscular blocking properties, particular caution should be exercised in patients with pre- existing neuromuscular diseases (e.g. The usual total daily dose of ZOSYN for adults is 3.375 g every six hours totaling 13.5 g (12.0 g piperacillin/1.5 g tazobactam). 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. Hearing loss is usually manifested initially by diminution of high-tone acuity. If the causative organisms are resistant to gentamicin, other appropriate therapy should be instituted.In serious infections when the causative organisms are unknown, gentamicin sulfate may be administered as initial therapy in conjunction with a penicillin-type or cephalosporin-type drug before obtaining results of susceptibility testing.
– Dosage strictly according to creatinine clearance (or serum creatinine concentration). 2010 Smaller concentrations are found in the liver and gall bladder, the lung and spleen.Gentamicin crosses the placenta; the foetal concentrations can be 30% of the maternal plasma concentrations. Volume depletion or hypotension and liver disease have been reported as additional risk factors for nephrotoxicity.

A peak and trough concentration measured intermittently during therapy will provide optimal guidance for adjusting dosage.

Maintenance dose: 1.5 mg/kg IV/IM q8hr plus clindamycin IV or 3-5 mg/kg IV qDay. The dosage should be reduced to 3 mg/kg/day as soon as clinically indicated (It is desirable to measure both peak and trough serum concentrations of gentamicin to determine the adequacy and safety of the dosage. )Neuromuscular blockade and respiratory paralysis have been reported from administration of aminoglycosides to patients who have received curare-type muscle relaxants during anaesthesia. It allows continued monitoring of the benefit/risk balance of the medicinal product. – In patients with impaired renal function additionally receiving gentamicin locally (inhalation, intratracheal, instillation)

Therefore therapeutic application is parenteral.Higher peak and lower trough levels are found when the total daily dose is given as a single daily infusion.
Some opacity of the plastic due to moisture absorption during the sterilization process may be observed. A zone of 12 mm or less indicates that the infecting organism is likely to be resistant.

When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. It is bactericidal Bacterial resistance to gentamicin is generally developed slowly. Concentrations in renal cortex sometimes may be eight times higher than the usual serum levels.

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