硫酸ゲンタマイシン

動物種別の用量

投与経路

禁忌

• Known hypersensitivity to aminoglycosides
• Use with extreme caution in preexisting renal disease
• Use with caution in working dogs (e.g., seeing-eye, herding, hearing-impaired assistance dogs) due to irreversible ototoxicity
• Use with caution in patients with neuromuscular disorders (e.g., myasthenia gravis)
• Do not use in animals with botulism
• Use with caution in rabbits (adversely affects GI flora)
• Use with caution in neonates, geriatrics, and dehydrated patients
• Perforated tympanum (for aural preparations)
• Concurrent use of other nephrotoxic drugs
• Systemic use exceeding 7 days
• Pregnancy

有害事象

• Nephrotoxicity (tubular necrosis)
• Ototoxicity (auditory and vestibular; cats are highly sensitive to vestibular effects)
• Neuromuscular blockade
• Facial edema
• Pain or inflammation at the injection site
• Peripheral neuropathy
• Hypersensitivity reactions
• Rarely: GI signs, hematologic, and hepatic effects
• Nephrotoxicity (acute tubular necrosis)
• Ototoxicity (auditory and vestibular)
• Neuromuscular blockade (rare)
• Delayed epithelial healing of corneal ulcers (ophthalmic use)
• Local irritation

薬物相互作用

• Beta-lactam antibiotics (penicillins, cephalosporins) · Synergistic effects against some bacteria; however, potential for in vitro inactivation of aminoglycosides (do not mix in the same syringe/bag) and in vivo inactivation in patients with renal failure. · major
• Cephalosporins · Potential additive nephrotoxicity (well documented with older cephalosporins like cephalothin).
• Loop or Osmotic Diuretics (e.g., furosemide, torsemide, mannitol) · Concurrent use may increase the nephrotoxic or ototoxic potential of aminoglycosides.
• Other Nephrotoxic Drugs (e.g., cisplatin, amphotericin B, polymyxin B, vancomycin) · Increased risk for nephrotoxicity.
• Neuromuscular blocking agents & General anesthetics · Concomitant use could potentiate neuromuscular blockade.
• Amphotericin B · Increased risk of nephrotoxicity and ototoxicity · major
• Furosemide · Increased risk of nephrotoxicity and ototoxicity · major
• Heparin · In vitro chemical inactivation (do not mix in same syringe) · major
• Non-depolarizing muscle relaxants (Atracurium, Pancuronium, Vecuronium) · Enhanced neuromuscular blockade · major

モニタリング

• Clinical efficacy (resolution of clinical signs, negative cultures)
• Renal toxicity: Baseline and ongoing urinalysis (casts in urine are often the initial sign of impending nephrotoxicity), serum BUN, and creatinine
• Gross monitoring for vestibular (balance) or auditory (hearing) toxicity
• Therapeutic Drug Monitoring (TDM): Serum levels drawn at 1, 2, and 4 hours post-dose. Peak should be >20 mcg/mL; 4-hour trough should be <10 mcg/mL
• Urinalysis (monitor for cellular casts as an early indicator of tubular damage)
• Serum creatinine and BUN
• Hydration status
• Therapeutic Drug Monitoring (TDM): Peak >20 μg/ml, Trough <1 μg/ml
• Auditory and vestibular function

過量投与

In the event of an inadvertent overdose, three treatments are recommended: 1. **Hemodialysis**: Very effective in reducing serum levels, but rarely a viable option in veterinary medicine. 2. **Peritoneal dialysis**: Reduces serum levels but is much less effective than hemodialysis. 3. **Complexation**: Administration of ticarcillin (12-20 g/day in humans) is reportedly nearly as effective as hemodialysis in complexing and deactivating the drug.