gentamicin
Sources réglementaires consultées
Indications approuvées
- Infections graves dues à des germes sensibles, notamment sepsis, infections urinaires compliquées, respiratoires, intra-abdominales, cutanées, ostéoarticulaires et endocardite en association.
Contre-indications
Absolues
- Hypersensibilité à gentamicina ou à d’autres aminosides.
- Myasthénie.
Mises en garde cliniques
- Il peut provoquer une néphrotoxicité, une ototoxicité cochléaire ou vestibulaire irréversible et un bloc neuromusculaire ; surveiller la fonction rénale, l’audition, l’équilibre et les concentrations sériques. — CIMA/AEMPS, ficha técnica 51886
- Mise en garde majeure · Le risque augmente avec les fortes doses, les traitements prolongés, la déshydratation, l’âge avancé, l’insuffisance rénale et les autres médicaments néphrotoxiques ou ototoxiques. — CIMA/AEMPS, ficha técnica 51886
Interactions médicamenteuses
- SévèreAutres médicaments néphrotoxiques ou ototoxiques
Mécanisme: La toxicité rénale, cochléaire et vestibulaire peut être additive.
Recommandation: Éviter l’association si possible ; si elle est indispensable, intensifier le suivi pharmacologique, la créatinine et l’audiométrie.
CIMA/AEMPS, ficha técnica 51886
- SévèreDiurétiques de l’anse
Mécanisme: Ils peuvent augmenter l’ototoxicité, surtout lors d’une administration intraveineuse rapide.
Recommandation: Éviter l’association ou surveiller étroitement l’audition et la fonction rénale.
CIMA/AEMPS, ficha técnica 51886
- SévèreBloquants neuromusculaires et anesthésiques
Mécanisme: Le bloc neuromusculaire peut être potentialisé et provoquer une apnée.
Recommandation: Surveiller la fonction respiratoire et disposer d’une assistance ventilatoire ainsi que de calcium ou de néostigmine.
CIMA/AEMPS, ficha técnica 51886
Effets indésirables
Communs (≥1%)
Nausées, élévation de la créatinine et réaction au site d’administration
Rares mais graves
Insuffisance rénale, perte auditive irréversible, toxicité vestibulaire et bloc neuromusculaire avec apnée
Grossesse et allaitement
Éviter pendant la grossesse sauf infection grave sans alternative en raison du risque d’atteinte fœtale. De faibles quantités passent dans le lait ; évaluer l’allaitement selon l’état du nourrisson.
Bibliographie récente (PubMed)
- Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment.
Clinical chorioamnionitis, the most common infection-related diagnosis in labor and delivery units, is an antecedent of puerperal infection and neonatal sepsis. The condition is suspected when intrapartum fever is associated with two other maternal and fetal signs of local or systemic inflammation (eg, maternal tachycardia, uterine tenderness, maternal leukocytosis, malodorous vaginal discharge or amniotic fluid, and fetal tachycardia). Clinical chorioamnionitis is a syndrome caused by intraamniotic infection, sterile intraamniotic inflammation (inflammation without bacteria), or systemic maternal inflammation induced by epidural analgesia. In cases of uncertainty, a definitive diagnosis can be made by analyzing amniotic fluid with methods to detect bacteria (Gram stain, culture, or microbial nucleic acid) and inflammation (white blood cell count, glucose concentration, interleukin-6, interleukin-8, matrix metalloproteinase-8). The most common microorganisms are Ureaplasma species, and polymicrobial infections occur in 70% of cases. The fetal attack rate is low, and the rate of positive neonatal blood cultures ranges between 0.2% and 4%. Intrapartum antibiotic administration is the standard treatment to reduce neonatal sepsis. Treatment with ampicillin and gentamicin have been recommended by professional societies, although other antibiotic regimens, eg, cephalosporins, have been used. Given the importance of Ureaplasma species as a cause of intraamniotic infection, consideration needs to be given to the administration of antimicrobial agents effective against these microorganisms such as azithromycin or clarithromycin. We have used the combination of ceftriaxone, clarithromycin, and metronidazole, which has been shown to eradicate intraamniotic infection with microbiologic studies. Routine testing of neonates born to affected mothers for genital mycoplasmas could improve the detection of neonatal sepsis. Clinical chorioamnionitis is associated with decreased uterin
Non-cystic fibrosis (CF) bronchiectasis is a chronic lung condition caused by permanent bronchial dilatation and inflammation and is characterized by daily cough, sputum, and recurrent exacerbations. Approximately 500 000 people in the US have non-CF bronchiectasis. Non-CF bronchiectasis may be associated with prior pneumonia, infection with nontuberculous mycobacteria or tuberculosis, genetic conditions (eg, α1-antitrypsin deficiency, primary ciliary dyskinesia), autoimmune diseases (eg, rheumatoid arthritis, inflammatory bowel disease), allergic bronchopulmonary aspergillosis, and immunodeficiency syndromes (eg, common variable immunodeficiency). Up to 38% of cases are idiopathic. According to US data, conditions associated with non-CF bronchiectasis include gastroesophageal reflux disease (47%), asthma (29%), and chronic obstructive pulmonary disease (20%). The prevalence of non-CF bronchiectasis increases substantially with age (7 per 100 000 in individuals 18-34 years vs 812 per 100 000 in those ≥75 years) and is more common in women than men (180 vs 95 per 100 000). Diagnosis is confirmed with noncontrast chest computed tomography showing dilated airways and often airway thickening and mucus plugging. Initial diagnostic evaluation involves blood testing (complete blood cell count with differential); immunoglobulin quantification testing (IgG, IgA, IgE, and IgM); sputum cultures for bacteria, mycobacteria, and fungi; and prebronchodilator and postbronchodilator spirometry. Treatment includes airway clearance techniques; nebulization of saline to loosen tenacious secretions; and regular exercise, participation in pulmonary rehabilitation, or both. Inhaled bronchodilators (β-agonists and antimuscarinic agents) and inhaled corticosteroids are indicated for patients with bronchiectasis who have asthma or chronic obstructive pulmonary disease. Exacerbations of bronchiectasis, which typically present with increased cough and sputum and worsened fatigue, are associate
Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.