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Gentamicin is an aminoglycoside antibiotic used in the treatment of several gram-negative infections. It should be indicated based on patient age, symptoms, signs at presentation, and local antimicrobial resistance patterns to enhance the probability of successful treatment in bacterial septicemia, meningitis, urinary tract infections, gastrointestinal tract infections, and soft tissue infections. This activity aims to review the indications, action mechanism, and contraindications for gentamicin as a relevant agent in the therapy of nosocomial and community-acquired infections. This activity will also highlight the main administration routes, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring) pertinent to the healthcare team in using gentamicin. Objectives: Identify the mechanism of action of gentamicin. Describe the adverse effects of gentamicin. Review the appropriate monitoring for toxicity of gentamicin. Outline some interprofessional team strategies for improving care coordination and communication to enhance patient safety and treatment outcomes using gentamicin. Access free multiple choice questions on this topic.

The main toxicity that occurs from gentamicin systemic use is nephrotoxicity. Although a rare event, hypersensitivity reactions secondary to gentamicin administration can be severe, to the extent that cases requiring intensive care unit admissions exist in the literature.[17] There is no antidote for gentamicin toxicity, and the approach for gentamicin-induced hypersensitivity reaction is drug suspension combined with supportive treatment. The possible hypersensitivity manifestations are urticaria, eosinophilia, delayed-type hypersensitivity reaction (Stevens-Johnson syndrome and toxic epidermal necrolysis), angioedema, and anaphylactic shock. The clinical manifestations should guide the treatment strategy. In case of hypotension or even anaphylactic shock, intravenous fluids and vasoactive agents are the primary therapeutic options. Oxygen supplementation or mechanical ventilation may be necessary if respiratory distress occurs. When Stevens-Johnson syndrome or toxic epidermal necrolysis develops, the mainstay of treatment includes wound care, pain control, fluid and electrolyte management, and monitoring of superinfections. Nephrotoxicity, one of the most common adverse effects of gentamicin use, is associated with the therapy duration and not with serum concentrations. Generally, the glomerular filtration rate decrement is small and transient, and rarely progresses to oliguric-anuric renal failure. Likewise, ototoxicity is more common in long-term gentamicin therapy. Furthermore, cochlear and vestibular damage sometimes is irreversible and can be accumulated after repetitive gentamicin exposure; aspirin use may attenuate this ototoxicity risk.[18]

Gentamicin is a widely used antibiotic that has been an important part of medical practice since the 1940s. Although antimicrobial resistance is increasing, gentamicin remains a powerful option for many gram-negative infections, including severe cases. Clinicians must always try to determine whether the pathogen responsible for the infection is susceptible to gentamicin, enabling more accurate use of the antibiotic. Current evidence indicates that a high-dose, extended-interval dosing approach is at least as efficacious as traditional multiple-dose regimens but is less nephrotoxic and ototoxic and, therefore, should be used whenever possible. Doses must be calculated based on patient weight and adjusted according to the GFR. Nurses should remember that the infusion time must be at least 30 minutes and remain vigilant for hypersensitivity reactions. Pharmacists are essential for checking the prescribed dose, ensuring the necessary items for administration are available, and reviewing possible medication interactions. The healthcare team should be prepared to recognize and manage acute kidney injury and inner ear lesions, both potential adverse effects of gentamicin use. Open communication and collaborative work of all interprofessional team members can improve patient care and enhance treatment outcomes with gentamicin.