Gentamicin,sulfate,HOW,SUPPLIE health Gentamicin sulfate

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HOW SUPPLIED Injection: 40 mg/ml (adult), 10 mg/ml (pediatric) I. V. infusion (premixed): 40 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 120 mg in normal saline solution ACTION Inhibits protein synthesis by binding directly to the 30S ribosomal subunit. Usually bactericidal. INDICATIONS & DOSAGE Children: 2 to 2.5 mg/kg q 8 hours I.M. or by I. V. infusion. Neonates over age 1 week or infants: 2.5 mg/kg q 8 hours I.M. or by I. V. infusion. Neonates under age 1 week and pretenn infants: 2.5 mg/kg q 12 hours I.M. or by I.V. infusion. Meningitis - Adults: systemic therapy as above.Children: systemic therapy as above. Endocarditis prophylaxis for GI or GU procedure or surgery- Adults: 1.5 mg/kg LM. or LV. 30 minutes before procedure or surgery. Maximum dose is 80 mg. Given with ampicillin (vancomycin in penicillinallergic patients). Children: 2 mg/kg LM. or I.V. 30 minutes before procedure or surgery. Maxi­mum dose is 80 mg. Given with ampicillin (vancomycin in penicillin allergic patients). After hemodialysis to maintain thera­peutic blood levels - Adults: 1 to 1.7 mg/kg I.M. or by LV. inusion after each dialysis. Children: 2 to 2.5 mg/kg LM. or by 1. V. infusion after each dialysis. Dosage adjustment: For adult patients with impaired renal function, doses and frequency are determined by serum gentamicin levels and renal function.ADVERSE REACTIONS CNS: headache, lethargy, encephalopathy, confusion, dizziness, seizures, numb­ness, peripheral neuropathy, vertigo, ataxia, tingling. CV: hypotension. EENT: ototoxicity, blurred vision, tinnitus. GI: vomiting, nausea. GU: nephrotoxicity; possible elevation in BUN, nonprotein nitrogen, or serum cre­atinine levels; possible increase in urinary excretion of casts. Hematologic: anemia, eosinophilia, leukopenia, thrombocytopenia, agranulocytosis. Hepatic: increased ALT, AST, bilirubin, LD. Musculoskeletal: muscle twitching, myasthenia gravis-like syndrome. Respiratory: apnea. Skin: rash, urticaria, pruritus. Other: fever, anaphylaxis; injection site pain. INTERACTIONS Drug-drug. Acyclovir, amphotericin B, cisplatin, methoxyflurane, vancomycin, other aminoglycosides: increased ototoxicity and nephrotoxicity. Use together cautiously. Cephalosporins: increased nephrotoxicity. Use together cautiously. Dimenhydrinate: may mask symptoms of ototoxicity. Use with caution. General anesthetics, neuromuscular blockers: may potentiate neuromuscular blockade. Monitor closely. Indomethacin: may increase serum peak and trough levels of gentamicin. Serum gentamicin ]evels must be monitored closely. I. V. loop diuretics (such as furosemide): increased ototoxicity. Use cautiously. Parenteral penicillins (such as ampicillin and ticarcillin): gentamicin inactivation in vitro. Don't mix together. EFFECTS ON DIAGNOSTIC TESTS None reported. CONTRAINDICATIONS Contraindicated in hypersensitivity to drug or other aminoglycosidesSPECIAL CONSIDERATIONS " Use cautiously in neonates, infants, elderly patients, and patients with impaired renal function or neuromuscular disorders." A specimen for culture and sensitivity tests is obtained before first dose is given. " Patient's hearing must be evaluated before and during therapy. Patient complaints of tinnitus, vertigo, or hearing loss are important. " Patient's weight and renal function studies must be reviewed before therapy begins. " Alert: Preservative-free formulations of gentamicin are used when the intrathecal route is ordered. " Blood for peak gentamicin level is obtained I hour after I.M. injection or 30 minutes after LV. infusion finishes; for trough levels, blood is drawn just before next dose. Blood must not be collected in a heparinized tube; heparin is incompatible with aminoglycosides. " Peak blood levels over 10 mcg/ml and trough levels over 2 mcg/m] may be associated with higher incidence of toxicity. " Urine output, specific gravity, urina]y­sis, BUN and creatinine levels, and crea­tinine clearance must be monitored. " Hemodialysis for 8 hours removes up to 50% of drug from blood. " Superinfection (continued fever and other signs and symptoms of new infection, especially of upper respiratory tract) may occur. " Therapy usually continues for 7 to 10 days. If no response occurs in 3 to 5 days, therapy may be stopped and new specimens obtained for culture and sensitivity testing. I. V. administration " When giving by intermittent LV. infusion, the drug is diluted with 50 to 200 ml of Ds W or normal saline injection and infused over 30 minutes to 2 hours. After completing LV. infusion, the line is flushed with normal saline solution or Ds W. Patient teathing " Maintain adequate fluid intake and report adverse reactions promptly. " Don't perform hazardous activities if adverse CNS reactions occur.