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Aminoglycoside Antibiotic (Topical) Pregnancy: D

Gentamicin (Burns — Topical)

Brand names: Cidomycin, Gentamicin Cream

Adult dose

Dose: 0.3% cream or ointment applied to affected area 3–4 times daily; IV systemic: 5 mg/kg once daily
Route: topical or IV
Frequency: three to four times daily (topical); once daily (IV extended interval)
Max: Topical: apply thin layer only; IV: 7 mg/kg/day initially (once-daily)
Topical: Gram-negative wound infections, infected burns; systemic IV: once-daily dosing preferred for burns sepsis; Hartford nomogram for dose adjustment

Paediatric dose

Dose: 2.5 mg/kg
Route: IV
Frequency: every 8 hours (or once daily 7 mg/kg in >1 month)
Max: 7 mg/kg/day
Concentration: 10 mg/mL or 40 mg/mL injection mg/ml
Neonates: 2.5 mg/kg every 36h (<28 weeks); every 24h (28–34 weeks); every 18h (>34 weeks); therapeutic drug monitoring essential

Dose adjustments

Renal

Once-daily: Hartford nomogram; avoid if eGFR <20 ml/min unless no alternative (with TDM)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Neonates: 2.5 mg/kg every 36h (<28 weeks); every 24h (28–34 weeks); every 18h (>34 weeks); therapeutic drug monitoring essential

Clinical pearls

  • Once-daily dosing (5–7 mg/kg) is as effective and less nephrotoxic than thrice-daily in burns — standard in most UK burns units
  • TDM: pre-dose level target <1 mg/L (once-daily); ensure 18–24h washout before measuring
  • Burns patients have increased Vd (protein loss, oedema) — often require higher initial doses

Contraindications

  • Previous vestibulotoxicity or nephrotoxicity to aminoglycosides
  • Myasthenia gravis

Side effects

  • Nephrotoxicity
  • Ototoxicity (auditory and vestibular)
  • Neuromuscular blockade (large doses)
  • Topical: contact sensitisation

Interactions

  • Loop diuretics (furosemide — enhanced ototoxicity)
  • Ciclosporin (nephrotoxicity)
  • Neuromuscular blocking agents
  • Vancomycin (nephrotoxicity)

Monitoring

  • Serum levels (pre-dose <1 mg/L once-daily; or Hartford nomogram)
  • eGFR every 48h
  • Audiometry if prolonged use

Reference: BNFc; BNF 86; Burns unit guidelines; Hartford nomogram. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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