gentamicin
Fuentes regulatorias consultadas
Indicaciones aprobadas
- Infecciones graves por microorganismos sensibles, incluidas sepsis, infecciones urinarias complicadas, respiratorias, intraabdominales, cutáneas, osteoarticulares y endocarditis en combinación.
Contraindicaciones
Absolutas
- Hipersensibilidad a gentamicina o a otros aminoglucósidos.
- Miastenia gravis.
Advertencias clínicas
- Puede causar nefrotoxicidad, ototoxicidad coclear o vestibular irreversible y bloqueo neuromuscular; controla función renal, audición, equilibrio y concentraciones séricas. — CIMA/AEMPS, ficha técnica 51886
- Advertencia mayor · El riesgo aumenta con dosis altas, tratamiento prolongado, deshidratación, edad avanzada, insuficiencia renal y otros nefro- u ototóxicos. — CIMA/AEMPS, ficha técnica 51886
Interacciones medicamentosas
- SeveraOtros nefrotóxicos u ototóxicos
Mecanismo: La toxicidad renal, coclear y vestibular puede ser aditiva.
Recomendación: Evita la combinación si es posible; si es imprescindible, intensifica TDM, creatinina y audiometría.
CIMA/AEMPS, ficha técnica 51886
- SeveraDiuréticos de asa
Mecanismo: Pueden aumentar la ototoxicidad, especialmente por vía intravenosa rápida.
Recomendación: Evita la combinación o controla estrechamente audición y función renal.
CIMA/AEMPS, ficha técnica 51886
- SeveraBloqueantes neuromusculares y anestésicos
Mecanismo: El bloqueo neuromuscular puede potenciarse y causar apnea.
Recomendación: Vigila la función respiratoria y ten disponible soporte ventilatorio y calcio o neostigmina.
CIMA/AEMPS, ficha técnica 51886
Eventos adversos
Comunes (≥1%)
Náuseas, elevación de creatinina y reacción en el lugar de administración
Raros pero graves
Insuficiencia renal, pérdida auditiva irreversible, toxicidad vestibular y bloqueo neuromuscular con apnea
Embarazo y lactancia
Evita durante el embarazo salvo infección grave sin alternativa por riesgo de lesión fetal. Pasa a la leche en cantidades pequeñas; valora la lactancia según el estado del lactante.
Bibliografía reciente (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.