BY INTRAMUSCULAR OR BY SLOW INTRAVENOUS INJECTION OVER AT LEAST 3 MINUTES OR BY INTRAVENOUS INFUSION, 3 - 5 MG/KG DAILY (IN DIVIDED DOSES EVERY 8 HOURS), NEONATE UP TO 2 WEEKS, 3 MG/KG EVERY 12 HOURS; CHILD 2 WEEKS - 12 YEARS, 2 MG/KG EVERY 8 HOURS
ENDOCARDITIS (IN COMBINATION WITH OTHER ANTIBACTERIALS, ADULT 1 MG/KG EVERY 8 HOURS( WITH BENZYLPENICILLIN + GENTAMICIN FOR 2 WEEKS.)
ENDOCARDITIS CAUSED BY ENTEROCOCCI (E.G. ENTEROCOCCUS FAECALIS) :
AMOXICILLIN (OR VANCOMYCIN IF PENICILLIN-ALLERGIC OR PENICILLIN-RESISTANT) + GENTAMICIN
TREAT FOR AT LEAST 4 WEEKS (AT LEAST 6 WEEKS FOR PROSTHETIC VALVE ENDOCARDITIS); IF GENTAMICIN-RESISTANT, SUBSTITUTE GENTAMICIN WITH STREPTOMYCIN
ENDOCARDITIS CAUSED BY HAEMOPHILUS, ACTINOBACILLUS, CARDIOBACTERIUM, EIKENELLA, AND KINGELLA SPECIES (βHACEKβ ORGANISMS)
AMOXICILLIN((OR CEFTRIAXONE IF AMOXICILLIN-RESISTANT) + LOW-DOSE GENTAMICIN
TREAT FOR 4 WEEKS (6 WEEKS FOR PROSTHETIC VALVE ENDOCARDITIS); STOP GENTAMICIN AFTER 2 WEEKS
ONCE DAILY DOSE REGIMEN, BY INTRAVENOUS INFUSION, INITIALLY 5 - 7 MG/KG, THEN ADJUSTED ACCORDING TO SERUM-GENTAMICIN CONCENTRATION
BY INTRATHECAL INJECTION, SEEK SPECIALIST ADVICE, 1 MG DAILY (INCREASED IF NECESSARY TO 5 MG DAILY)
NOTE FOR MULTIPLE DAILY DOSE REGIMEN, ONE-HOUR (βPEAK') SERUM CONCENTRATION SHOULD BE 5 - 10 MG/LITRE (3 - 5 MG/LITRE FOR ENDOCARDITIS); PRE-DOSE (βTROUGH') CONCENTRATION SHOULD BE LESS THAN 2 MG/LITRE (LESS THAN 1 MG/LITRE FOR ENDOCARDITIS).
SODIUM FUSIDATE IS GIVEN AS TABLETS IN A USUAL ADULT DOSE OF 500 MG BY MOUTH EVERY 8 HOURS, ALTHOUGH THIS DOSE MAY BE DOUBLED IN SEVERE INFECTION. FOR CUTANEOUS STAPHYLOCOCCAL INFECTIONS, A DOSE OF 250 MG TWICE DAILY IS SUITABLE.
GENTAMICIN HAS SOMETIMES BEEN GIVEN BY MOUTH FOR ENTERIC INFECTIONS AND TO SUPPRESS INTESTINAL FLORA AND HAS OCCASIONALLY BEEN GIVEN BY INHALATION IN CYSTIC FIBROSIS. IN MENINGITIS IT HAS BEEN GIVEN INTRATHECALLY OR INTRAVENTRICULARLY USUALLY IN DOSES OF 1 TO 5 MG DAILY WITH INTRAMUSCULAR THERAPY. GENTAMICIN HAS ALSO BEEN GIVEN BY SUBCONJUNCTIVAL INJECTION.
GENTAMICIN HAS ALSO BEEN APPLIED TOPICALLY FOR SKIN INFECTIONS IN CONCENTRATIONS OF 0.1%, BUT SUCH USE MAY LEAD TO THE EMERGENCE OF RESISTANCE AND IS CONSIDERED INADVISABLE. CONCENTRATIONS OF 0.3% ARE USED IN PREPARATIONS FOR TOPICAL APPLICATION TO THE EYES AND EARS.