BNF for Children 2011-2012

BNFC 2011–2012 5.1.4 Aminoglycosides 279Genticin c (Amdipharm) AInjection, gentamicin (as sulphate) 40 mg/mL. Netprice 2-mL amp = £1.40Isotonic Gentamicin Injection (Baxter) AIntravenous infusion, gentamicin (as sulphate)800 micrograms/mL in sodium chloride intravenousinfusion 0.9%. Net price 100-mL (80-mg) Viaflex cbag = £1.61Electrolytes Na + 15.4 mmol/100-mL bagAMIKACINCautions see under Gentamicin; interactions:Appendix 1 (aminoglycosides)Contra-indications see under GentamicinRenal impairment see notes abovePregnancy see notes aboveSide-effects see under GentamicinPharmacokinetics Multiple dose regimen: one-hour(‘peak’) serum concentration should not exceed30 mg/litre; pre-dose (‘trough’) concentrationshould be less than 10 mg/litreOnce daily dose regimen: pre-dose (‘trough’) concentrationshould be less than 5 mg/litreLicensed use dose for cystic fibrosis not licensedIndication and doseTo avoid excessive dosage in obese children, use idealweight for height to calculate dose and monitorserum-amikacin concentration closelyNeonatal sepsis. Extended interval dose regimen by slow intravenousinjection over 3–5 minutes or by intravenousinfusionNeonate 15 mg/kg every 24 hours. Multiple daily dose regimen by intramuscularor by slow intravenous injection or by infusionNeonate loading dose of 10 mg/kg then 7.5 mg/kg every 12 hoursSerious Gram-negative infections resistant togentamicin. By slow intravenous injection over 3–5 minutesChild 1 month–12 years 7.5 mg/kg every 12hoursChild 12–18 years 7.5 mg/kg every 12 hours,increased to 7.5 mg/kg every 8 hours in severeinfections, max. 500 mg every 8 hours for up to 10days (max. cumulative dose 15 g)Once daily dose regimen (not for endocarditisor meningitis). By intravenous injection or infusionChild 1 month–18 years initially 15 mg/kg, thenadjusted according to serum-amikacin concentrationPseudomonal lung infection in cystic fibrosis. Multiple daily dose regimen by slow intravenousinjection or infusionChild 1 month–18 years 10 mg/kg every 8 hours(max. 500 mg every 8 hours)Note Local dosage guidelines may varyAdministration for intravenous infusion, dilute withGlucose 5% or Sodium Chloride 0.9%; give over 30–60 minutesAmikacin (Non-proprietary) AInjection, amikacin (as sulphate) 250 mg/mL. Netprice 2-mL vial = £10.14Electrolytes Na + 0.56 mmol/500-mg vialAmikin c (Bristol-Myers Squibb) AInjection, amikacin (as sulphate) 50 mg/mL. Netprice 2-mL vial = £2.07Electrolytes Na + < 0.5 mmol/vialTOBRAMYCINCautions see under Gentamicin; interactions:Appendix 1 (aminoglycosides)Specific cautions for inhaled treatment Other inhaleddrugs should be administered before tobramycin; monitor forbronchospasm with initial dose, measure peak flow beforeand after nebulisation—if bronchospasm occurs, repeat testusing bronchodilator; monitor renal function before treatmentand then annually; severe haemoptysisContra-indications see under GentamicinRenal impairment see notes abovePregnancy see notes aboveSide-effects see under Gentamicin; on inhalation,mouth ulcers, taste disturbances, voice alteration,cough, bronchospasm (see Cautions)Pharmacokinetics Extended interval dose regimenin neonates: pre-dose (‘trough’) concentrationshould be less than 2 mg/litreOnce daily dose regimen: pre-dose (‘trough’) concentrationshould be less than 1 mg/litreMultiple daily dose regimen: one-hour (‘peak’)serum concentration should not exceed 10 mg/litre(8–12 mg/litre in cystic fibrosis); pre-dose (‘trough’)concentration should be less than 2 mg/litreIndication and doseTo avoid excessive dosage in obese children, use idealweight for height to calculate parenteral dose andmonitor serum-tobramycin concentration closelyNeonatal sepsis. Extended interval dose regimen by intravenousinjection over 3–5 minutes or by intravenousinfusionNeonate less than 32 weeks postmenstrual age4–5 mg/kg every 36 hoursNeonate 32 weeks and over postmenstrual age4–5 mg/kg every 24 hours. Multiple daily dose regimen by intramuscularinjection or by slow intravenous injection or byintravenous infusionNeonate under 7 days 2 mg/kg every 12 hoursNeonate 7–28 days 2–2.5 mg/kg every 8 hoursSepticaemia, meningitis and other CNS infections,biliary-tract infection, acute pyelonephritis,pneumonia in hospital patients. Multiple daily dose regimen by slow intravenousinjection over 3–5 minutesChild 1 month–12 years 2–2.5 mg/kg every 8hours5 Infections