Gent

[pooh54]

Hey everyone, hoping you can help me. We have a new nurse on the unit, she is suggesting diluting gent to a total infusion of 6 cc's. I've never diluted, always followed with a flush thru the med line. Is this a better way of doing things? I'm a little concerned about the volume, especially with diluting amp 2x this way in one day. thanks

[Gompers, BSN, RN]

We use Gent pretty often, I have to say. Most of our new admits get put on Amp and Gent, plus it's the combo the docs usually order for babies down the road when they're suddenly acting septic. They usually don't deviate from that unless the baby has a positive culture indicating different antibiotic needs, or if the baby is exibiting signs of renal failure.

For full-term newborns, it's 4mg/kg of Gent Q24H.

For preemies, it's 2.5mg/kg of Gent Q24H.

We do peaks and troughs with the third dose if the plan is to keep the baby on antibiotics beyond those first three days. We'll go to Q36H dosing if the baby's Gent level is high.

We give the pre-made 10mg/ml solution over a pump for 30 minutes.

(Ampicillin - we give the 100mg/ml dilution slow IV push, but I agree that it's so irritating to their veins! I think we should further dilute it if we're giving through a peripheral IV - and usually the kinds of kids who need major fluid restrictions have central lines anyways, so wouldn't have to dilute their doses anyways...)

[Mimi2RN, ASN, RN]

We rarely use Gent anymore, only if they really need it. Doesn't the Neofax say 4mg/kg q 24 hour for term babies, and q 48 hours for premies, and give over 30 minutes?

That meant to us that a premie would barely get two doses before it was d/c'd. As we did levels around the third dose, they didn't often get levels. Now we usually use Amp and Claforan. We now have hospitalists, and have had lots of changes in the last couple of years.

I like to push the amp, especially on a PIV. I get a feel for the IV site, if it was good last night, and tonight it's slow, I'll replace the PIV before I give the meds.

[pooh54]

Thanks to all of you who've answered! We're following the new guidelines for gent and get the peak after the first dose and adjust dosing times based on that and the trough before the second. I think the biggest problem is the nurses not documenting the amount of fluid given, with some of our peanuts, the volume of both a diluted gent and amp have to be taken into consideration. i.e for a 1280 grammer. Probably sounds HUGE for those of you that deal with the micros! :chuckle

[asher315]

One of our ped groups gives amp and gent with the gent given every 24 hrs and they say there is no need for P&T with this schedule. The amp we can push and it is diluted to 25mg/ml and the gent is given over 30 mins at a 2mg/ml dilultion.

Of course most of our babes are > 2000 gms.