From the Guidelines
The best protocol for intravesical gentamicin involves instilling a solution with a concentration of 14 mg/ml, which can be prepared by withdrawing 2 ml from an injectable vial of intravenous gentamicin (40 mg/ml) and adding it to a 5-ml bottle, then refrigerating and shaking well before instillation. This approach is based on the preparation method described in the study on bacterial keratitis preferred practice pattern 1. When considering the use of intravesical gentamicin, it's crucial to prioritize the patient's morbidity, mortality, and quality of life.
To prepare the solution, the following steps can be followed:
- Withdraw 2 ml from an injectable vial of intravenous gentamicin (40 mg/ml)
- Add the withdrawn 2 ml to a 5-ml bottle to give a 14 mg/ml solution
- Refrigerate and shake well before instillation, as indicated in the study 1.
However, the specific protocol for intravesical administration, including the volume of the solution, dwell time, and frequency of administration, is not directly addressed in the provided evidence. In clinical practice, the typical approach involves instilling the prepared gentamicin solution directly into the bladder through a catheter, with careful consideration of the patient's individual needs and response to treatment. Monitoring for potential side effects and assessing treatment efficacy through urine culture and symptom evaluation are essential components of the treatment protocol.
From the Research
Intravesical Gentamicin Protocol
- The best protocol for intravesical gentamicin is not explicitly stated in the provided studies, but some information can be gathered from the available data 2.
- A study on intravesical instillation of gentamicin sulfate found that it has a low risk of absorption and is highly effective against common urinary pathogens 2.
- The study also found that storage up to two months at room temperature without alkalinization had no effect on potency, suggesting that gentamicin sulfate can be stored for a relatively long period without losing its effectiveness 2.
Administration Methods
- A clinical trial study compared single-dose and multiple-dose administration methods of gentamicin and found that single-dose administration minimized nephrotoxicity and ototoxicity compared to multiple doses 3.
- Another study compared once-daily netilmicin with gentamicin treatment in patients with serious infections and found no significant differences in nephrotoxicity or ototoxicity between the two groups 4.
Toxicity and Efficacy
- A study on gentamicin-induced ototoxicity and nephrotoxicity found that the severity of these adverse effects varied with circadian time of daily treatment, with more severe effects observed when treatment was administered at the beginning of the activity span 5.
- The study also found that ototoxicity and nephrotoxicity were independent phenomena, with separate mechanisms and time courses 5.