GENTAMYCIN, AMIKACIN and AZITHROMYCIN

GENTAMYCIN

It comes from the Micromonospora purpurea plant. It is the most widely used, least expensive, and strongest aminoglycoside.

Dose

• Adult
  • IM or IV 5mg/kg/day in either single or divided doses.
• Child
  • IM or IV: 2 mg/kg/day or 5-7.5 mg/kg as a single dosage, administered every eight hours.
• New Born and Infant
  • 3 mg/kg/day *g/day *ay bid
• Surgical Prophylaxis
  • 2mg/k*g IV once during anesthesia induction

Nursing Consideration

• Identify past usage of and reactions to aminoglycosides by obtaining a history.
• If your patient exhibits any symptoms of hypersensitivity, such as fever, wheezing, skin rashes, generalized itching, or dyspnea, stop the medicine and tell the doctor right away.
• Intravenous solutions should be started gradually at initially while being closely monitored for sensitive response.
• Before administering a medication dose, get samples for culture and sensitivity testing.
• Give medication continuously to keep blood levels stable. Never skip a dose.
• A big muscle should receive an IM injection.
• Before and after therapy, test your auditory and vestibular function. 3–4 weeks after the medicine is stopped, recheck your auditory and vestibular systems.
• Keep an eye out for symptoms of renal toxicity, such as atypical urine appearance (black, murky), intake and output ratios, and oedema.
• If your patient exhibits symptoms of hypersensitivity, such as fever, wheezing, skin rashes, generalized itching, or dyspnea, stop the medicine and call your doctor right once.

AMIKACIN

It is a partially synthetic Kanamycin derivative. It is suggested as a backup medication for gram-negative bacillary infections obtained in hospitals when there is a high level of resistance to other aminoglycosides.

Dose

• Adult
  • IM 1.5gm maximum per day in 2-3 divided doses, with a maximum daily dose of 15mg/kg.
• Child
  • 15 mg/kg/day in two doses
• Pre - Term
  •  0-14days
    • once daily at 10mg/kg,
• Under 29 Weeks
  • once daily, 7.5mg/kg
• Term
  • 0-7 days
    • 15 mg/kg every day
• Greater than 7 days
  • once daily at 22mg/kg

Nursing Considerations

• 5mg/ml of dilution is sufficient. Mixing with IV solutions, blood, or blood products is not recommended.
• Use a syringe pump to provide by gradual IV infusion over 30 minutes.
• Trough and peak levels 30 minutes after the infusion ends and one hour after it starts.
• Keep an eye out for further vasospasm while administering.
• During prolonged therapy, keep an eye out for any indicators of renal, hepatic, and hemologic failure.
• Keep an eye out for symptoms of renal toxicity, such as atypical urine appearance (black, murky), intake and output ratios, and oedema.
• Before and after therapy, test your auditory and vestibular function. 3–4 weeks after the medicine is stopped, recheck your auditory and vestibular systems.

AZITHROMYCIN

It is a more tolerable, extended spectrum medication. Compared to erythromycin, it is less effective against streptococci and staphylococci.

Indication

• Infection with the Micobacterium Avium Complex (MAC)
• Infection with a Legionnaire
• Infection of the respiratory system
• Calymmatobacterium, infection from campylobacter.
• Chlamydia, gonorrhea, and N.

Dose

• Adult
  • 3 days of one 500mg dose every day. Or (alternatively initial dose of 500mg and followed by 250mg daily for a further 4 days) (alternatively initial dose of 500mg and followed by 250mg daily for a further 4 days).
• Easily Treatable Genital Infection
  • 2gm for uncomplicated gonorrhea, but 1gm for a single dose.
• For MAC Infection
  • once weekly, 1.2gm
• Enteric Fever
  • 20 mg/kg/day/day/od (up to 1 gram/day)
• Child
  • 5 to 10 mg per kilogram per day for three days.

Contraindication

• Hypersensitivity to maceolides and a compromised liver

Side Effect

• Nausea
• Vomiting
• Epigastric Discomfort
• Diarrhea
• Headache
• Vertigo
• Dizziness
• Palpitations
• Cholestatic Jaundice
• Increase in Hepatic Enzymes
• Hypotension, and Rashes
• Urticaria, and Angioedema.