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I have a question about Aminoglycoside Once daily dosing. I have read the
concensus report and appreciate the work and effort done in putting it
together. My question involves the administration of the drug. Is there
any information about giving the dose IM? I understand that the kinetics
should not really differ that much and it would be a big advantage to be
able to give these doses IM for homecare patients who have IV access only
for this therapy. Certainly to avoid the complications of open IV access
would be a significant advantage in some patients. The only drawback I can
think of is the volume of drug to be given. I would like to see some
feedback on this clinical question. Thank You.
Roy L. Mellovitz RPh
Medical and Regulatory Affairs
Rafa Laboratories, Jerusalem
rafa_lab.-a-.netvision.net.il
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Roy L. Mellovitz RPh scribbled:"Is there any information about giving the dose
IM? I understand that the kinetics should not really differ that much and it
would be a big advantage to be able to give these doses IM for homecare
patients who have IV access only for this therapy."
Gentamicin can be given IM. Although I have never been given gentamicin
personally, I have been told that IM dosing is VERY painful. Just need to look
at the faces of the patients as you are giving it to get an idea of how painful
it is!!! OUCH!
Regards,
Dave
Pharmacist (Australia)
psycho.-at-.merlin.net.au
http://www.merlin.net.au/~psycho
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Dear Roy
> Is there
> any information about giving the dose IM?
There is some information in this area, although as far as I am aware only
for conventional dosing regimens. To date it appears that the absorption
rate may be highly variable with repeated dosing which makes interpretation
of "peak" concentrations more difficult.
>The only drawback I can
> think of is the volume of drug to be given.
I think that this would be a considerable draw back. On average we give
our patients about 320 to 400 mg. This represents between 8 and 10 ml,
which would constitute a rather painful injection. (Some of our patients
may require as much as 600-800 mg/day!). So far, our "at home" patients
get gent IV by either coming into an outpatient clinic once/day or are
administered gent by a home care nurse.
I hope this helps.
Regards, Steve
========================
Steve Duffull
Christchurch
New Zealand
Ph +64 3 3815280
Fax +64 3 3640902
Email sduffull.aaa.clear.net.nz
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I think there is no reason to give aminoglycosides outside of a hospital
and not in combination with beta-lactam antibiotics. There are a lot of
toxic side effects. Therefore we want to avoid the use of
amonoglycosides at our ICU. In some cases we are forced to give them. We
combine them with beta-lactam antibiotics (for instance piperacilline)
and measure the serum drug levels. How do you want to control your
therapy?
Regards
--
Dr. Harald Mertes
Anaesthesiologist
Rastatt/Germany
mailto:harald.-at-.mertes.inka.de
http://www.inka.de/sites/mertes/eharald.html
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Dear Dr. Mellovitz:
Yes, in my experience, gentamicin and Amikacin have been given IM not
infrequently, especially when IV access is difficult at times. Dr. Dmiter
Terziivanov in Sofia, Bulgaria, has a good data set for patients receiving
IM Amikacin. Serum peaks are usually at about 1 hr after the dose. At our
hospital it is given IM as above, when IV access is occasionally difficult,
as an alternate route. Dr. T's email address is
ttsonev.-a-.obzor.bio21.acad.bg
terzi.at.obzor.bio21.acad.bg
Hope this helps,
Roger Jelliffe
************************************************
Roger W. Jelliffe, M.D.
USC Lab of Applied Pharmacokinetics
CSC 134-B, 2250 Alcazar St, Los Angeles CA 90033
Phone (213)342-1300, Fax (213)342-1302
email=jelliffe.-a-.hsc.usc.edu
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