Management of Once Daily Intravenous Gentamicin in Children (1216)

Contra-indications to gentamicin therapy: hypersensitivity; myasthenia gravis.

Caution to gentamicin therapy: neonates and infants less than 44 weeks corrected gestational age (CGA); obesity; renal impairment; concurrent administration of neurotoxic and / or nephrotoxic agents that increase the risk of gentamicin toxicity.

Review therapy and consider amending or withholding nephrotoxic drugs during gentamicin treatment. Avoid co-administration with the following: neuromuscular blockers, other potentially nephrotoxic (e.g. NSAIDs and ACE Inhibitors) or ototoxic drugs, potent diuretics, and other aminoglycosides.

This is not an exhaustive list, refer to BNFc and SPC for further information on cautions and contraindications.

Calculate the first dose of Gentamicin as follows:

Patients with Normal Renal function

Patients with RENAL IMPAIRMENT

Note: Above doses refer to treatment doses only. Refer to Antibiotic for prophylaxis surgery for IV Gentamicin dosing in surgical prophylaxis.

Discuss with ID/microbiology and document in the patients notes if treatment continues beyond 3 doses. Risks of prolonged treatment must be considered.

For first dose calculate as per ‘Ideal Body Weight’ at corresponding height centile using RCPCH growth charts.

• PROMPT ADMINISTRATION within 1 hour of recognition of sepsis reduces mortality.
• Refer to MEDUSA Monographs on Staffnet for Paediatric IV Gentamicin administration.  

Prescribe on HEPMA/Kardex as ‘As per Chart’ AND prescribe doses on the RHC IV Gentamicin PAM chart.

Refer to page 2 of the RHC IV Gentamicin PAM chart for further information on monitoring and dose adjustments. Contact a paediatric pharmacist for further advice if needed.

• Gentamicin level and U&E/Cr must been taken immediately prior to the second dose (trough).
• A peak level is NOT routinely required in children.
• Document the EXACT time and date the infusion administered and the EXACT time and date the sample was taken on the RHC IV Gentamicin PAM chart.
• DO NOT take the sample from the same line used for gentamicin administration.
• In patients with normal renal function-give the next dose (same as first e.g. 7mg/kg every 24 hours) do not wait for the trough level. If reported trough is out with target trough level, DO NOT administer further doses until within target range. Discuss ongoing management with a paediatric pharmacist.
• If the patient has impaired renal function, DO NOT give subsequent doses until the trough and repeat U&E/Cr are known. Subsequent doses should be based on renal function.
• Check gentamicin trough level at least every 2 days. Minimum daily for patients with impaired renal function.
• U&Es and creatinine should be checked with each gentamicin trough level to monitor renal function.
• Assess the patients fluid status daily specifically to ensure the patient has adequate fluid intake and is passing sufficient amounts of urine.
• If serum creatinine increases by 25% or more, or urine output deteriorates during treatment, take a gentamicin trough level immediately before the next scheduled dose. DO NOT give a further dose until the gentamicin trough level is confirmed as within target. Discuss ongoing management with a paediatric pharmacist.
• Extra gentamicin levels may be needed if the patient’s clinical picture has changed.

• Were dose and sample times recorded accurately?
• Was the correct dose administered?
• Was the sample taken from the line used to administer the drug?
• Was the sample taken during drug administration?
• Has there been a change in the patient’s clinical status – e.g. change in renal function, oedema, ascites or worsening sepsis?

If in doubt take another sample before re-prescribing and/or contact paediatric pharmacist for advice.

Renal: reduced urine output/oliguria or increased creatinine (increase ≥25% from baseline).  

Oto-vestibular: NEW tinnitus, dizziness, poor balance, hearing loss, oscillating vision. Toxicities may occur irrespective of gentamicin concentration.

Patients and their carers must be provided with a Gentamicin Patient Information leaflet (PIL) by the primary team looking after the patient.

DO NOT DELAY ADMINISTERING GENTAMICIN for providing the Gentamicin PIL to the patient and their carers. Prescribe and administer gentamicin and provide the information leaflet as soon as reasonably possible.    

Record in the patient’s notes or on Clinical Portal when the Gentamicin PIL has been issued.