Z-Gentamicin 80 mg/2 ml Injection

Aminoglycoside antibiotic for:

• Injection (hospital): serious Gram-negative infections — septicaemia, neonatal sepsis, complicated urinary tract and kidney infections, pneumonia in hospital, abdominal infections; endocarditis (with penicillin); surgical prophylaxis
• Eye/ear drops 0.3%: bacterial conjunctivitis, blepharitis, outer ear infection
• Cream/ointment 0.1%: superficial bacterial skin infections

Injection — given by health professionals with blood level monitoring:

• Adults: once-daily dosing 5–7 mg/kg IV (adjusted by levels), or 3–5 mg/kg/day in divided doses every 8 hours; endocarditis 1 mg/kg every 8–12 hours with penicillin.
• Children (over 1 month): 7 mg/kg once daily, or as per local guidelines; neonates 4–5 mg/kg every 24–36 hours depending on age.
• Kidney impairment: dose and interval adjusted by levels.
• Usual course up to 7 days to limit toxicity.

Eye drops: 1–2 drops every 4 hours (severe: every hour initially).

Ear drops: 2–3 drops 3–4 times daily.

Cream: apply 3–4 times daily.

• Allergy to aminoglycosides
• Myasthenia gravis
• Ear drops: perforated eardrum or grommets (risk of permanent hearing damage)

Injection — serious: kidney damage (usually reversible), hearing loss, ringing in ears and balance problems (may be permanent), neuromuscular blockade (breathing weakness), low magnesium.

Less common: rash, nausea, vomiting.

Eye/ear drops: stinging, irritation, allergic reactions.

Cream: irritation; prolonged use may cause resistance or sensitisation.

• Monitor blood levels and kidney function; check hearing if possible.
• Elderly, dehydration, kidney disease, pre-existing hearing problems: higher risk.
• Avoid long courses and repeated courses.
• Mitochondrial gene variants (m.1555A>G) greatly increase hearing-loss risk.

Injection: avoid in pregnancy unless essential (risk of hearing damage to the baby). Small amounts in milk; generally compatible with breastfeeding. Topical use acceptable.

• Loop diuretics (furosemide) — ear damage
• Vancomycin, amphotericin, ciclosporin, cisplatin, NSAIDs, contrast media — kidney damage
• Neuromuscular blockers and anaesthetics — breathing weakness
• Penicillins — may inactivate gentamicin if mixed in the same infusion (give separately)

Kidney damage, ear damage, breathing weakness. Haemodialysis removes gentamicin.

Store below 30°C. Eye/ear drops: discard 4 weeks after opening.