GENTAMYCIN & PENTAVALENT
A Drug Study Presented to
The Faculty of the Nursing Department
Karen Eve S. Mirafuentes, RN
In Partial Fulfillment of
the fulfillments in NCM- 209
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS ROTATION
By
Peter John Paul N. Dapitanon, St.N
March 23, 2020
Generic Name
Gentamicin
Brand Name Garamycin
Classification Aminoglycoside Antibiotics
Mode of Action Gentamicin interferes w/ bacterial protein synthesis by binding to 30S and
50S ribosomal subunits resulting in a defective bacterial cell membrane.
Dose / Route Adult : IM/IV Severe infections 3-5 mg/kg/day 8 hrly for 7-10 days.
Alternatively, may also give 5-7 mg/kg once daily for the subsequent
doses, adjusted according to serum gentamicin concentration. UTI 160 mg
once daily. Topical/Cutaneous Skin infections As 0.1% cream/oint: Apply
to affected area 3-4 times/day. Otic Otitis externa As 0.3% ear drops:
Instill 2-3 drops in the affected ear 3-4 times a day and at night. Ophth
Superficial opth infections As 0.3% eye drops: Instill 1-2 drops into
affected eye up to 6 times/day, or more frequently if required. As 0.3%
eye oint: Place a small amount into the conjunctival sac 2-3 times/day.
Indication Given for patients with Superficial ophthalmic infections, otitis externa,
severe infections, urinary tract infections and skin infections.
Contraindication Hypersensitivity to gentamicin and other aminoglycosides. Topical
application into the ear for patients w/ known or suspected perforation of
ear drum.
Side Effects Nausea, vomiting, stomach upset, or loss of appetite may occur.
Pain/irritation/redness at the injection site may rarely occur.
Adverse Effects Ototoxicity, electrolyte disturbances (notably hypomagnesaemia, but also
hypocalcaemia and hypokalaemia); hypersensitivity reactions, blood
dyscrasias, purpura, nausea and vomiting, stomatitis, increased
aminotransferase and bilirubin serum levels; neurotoxicity (e.g.
encephalopathy, confusion, lethargy, hallucinations, convulsions, mental
depression); atrophy or fat necrosis at inj sites; pain, hyperaemia, and
conjunctival oedema (subconjunctival); severe retinal ischaemia (intra-
ocular); endotoxin reaction (IV); erythema, pruritus, photosensitivity
(topical).
Potentially Fatal: Nephrotoxicity, resp depression, muscular paralysis and
anaphylaxis.
Drug Interactions Additive effect w/ other neurotoxic and/or nephrotoxic drugs including
cephalosporins, methicillin, amphotericin B, ciclosporin, cisplatin, potent
diuretics (e.g. ethacrynic acid, furosemide) and neuromuscular blocking
agents (e.g. succinylcholine, tubocurarine). May potentiate the effect of
anticoagulants (e.g. warfarin, phenindione). May antagonise the effect of
neostigmine and pyridostigmine. Increased risk of hypocalcaemia w/
bisphosphonates. Increased risk of neuromuscular blockade w/ botulinum
toxin. Indometacin may increase the plasma concentration of gentamicin
in neonates.
Nursing ● Instruct patient to report signs of hypersensitivity, tinnitus, vertigo,
Interventions hearing loss,
rash, dizziness, or difficulty urinating.
● Advise patient of the importance of drinking plenty of liquids.
● Teach patients with a history of rheumatic heart disease or valve
replacement the
importance of using antimicrobial prophylaxis before invasive medical or
dental
procedures.
● Topical: Instruct patient to wash affected skin gently and pat dry. Apply
a thin film
of ointment. Apply occlusive dressing only if ordered by health care
professional.
Patient should assess skin and inform health care professional if skin
irritation develops or infection worsens.
● Keep pa Assess for infection (vital signs, wound appearance, sputum,
urine, stool, WBC) at
beginning of and throughout therapy.
● Obtain specimens for culture and sensitivity before initiating therapy.
First dose
may be given before receiving results.
● Evaluate eighth cranial nerve function by audiometry before and
throughout therapy. Hearing loss is usually in the high-frequency range.
Prompt recognition and
intervention are essential in preventing permanent damage. Also monitor
for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth
cranial nerve dysfunction is associated with persistently elevated peak
aminoglycoside levels. Aminoglycosides should be discontinued if tinnitus
or subjective hearing loss occurs.
● Monitor intake and output and daily weight to assess hydration status
and renal
function.
● Assess for signs of superinfection (fever, upper respiratory infection,
vaginal itching or discharge, increasing malaise, diarrhea).tient well
hydrated.
Generic Name
Pentavalent
Brand Name Quinvaxem
Classification Five different antigens combined, including one inactivated whole-cell
vaccine, two sub-unit vaccines (toxoids), one conjugate vaccine and one
recombinant vaccine.
Mode of Action Immune globulins provide passive immunization to infectious diseases by
providing antibodies. Immunization with vaccines and toxoids containing
bacterial or viral antigenic material results in endogenous production of
antibodies.
Dose / Route Deep IM inj Primary vaccination 3 doses of 0.5 mL at 1st 6 mth of life,
starting from 2 mth w/ at least 1 mth interval between subsequent doses.
Booster dose Given in the 2nd yr of life w/ at least 6-mth interval after
completion of primary vaccination schedule.
Indication Active immunisation in infants from 2 mth against DPT, poliomyelitis &
HIB. Booster dose for childn previously immunised w/ DTP, polio & Hib
antigens.
Contraindication Hypersensitivity to the vaccine or after previous inj. Encephalopathy of
unknown aetiology occuring w/in 7 days following previous vaccination
w/ pertussis-containing vaccine.
Side Effects Loss of appetite; irritability, abnormal crying, restlessness; somnolence;
inj site pain, redness & swelling (≤50 mm), fever (≥38°C). Diarrhoea,
vomiting; inj site swelling (>50 mm) & reactions including induration.
Adverse Effects • Persistent (>3 hours) inconsolable screaming
• Seizures
• Hypotonic, hypo responsive episode(HHE)
• Anaphylaxis
• Encephalopathy
Drug Interactions Adequate response may not be achieved w/ immunosuppressive therapy.
Nursing Monitor vital signs and check for unusual reaction at insertion site.
Interventions A feverish child can be cooled with a tepid sponge or bath, and by
wearing cool clothing. Extra fluids need to be given to feverish
children.
For the local reaction, a cold cloth applied to the site may ease the
pain
Paracetamol, at a dose of up to 15mg/kg every 6–8 hours with a
maximum of four doses in 24 hours is useful for the common
minor reactions. It eases pain and reduces fever.
References:
Cunha, J. (2018) Gentamicin. Retrieved on March 18, 2020 from rxlis.com
Lippincott, W. (2017) Nursing Drug Handbook. Philadelphia, Pennsylvania: Walters Kluer Health, Inc.
Pentavalent (2019) retrieved on March 18, 2020 from pubchem.ncbi.nlm.nih.gov
Vallerand, A. & Sanoski, C. (2019) Davis’s Drug Guide for Nurses – 16th Ed. Philadelphia, PA. F.A. Davis
Company
