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Thread: new study results on gentamicin instillation and uti prevention

  1. #41
    if you get a uti while doing daily gent instills it will be gent resistant.
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  2. #42
    Quote Originally Posted by crags View Post
    My Medicare part D provider allows for a three month supply of gentamicin, which is comprised of (75) 10 mL vials at a cost of $33.

    At 480 mL gent/liter of saline (per the referenced article) this would allow approximately 1 1/2 L of compounded mixture.

    If one assumes an instillation amount of 40 mL (article's range was 30-60 mL), then one and a half liters of compounded mixture would give a little over one month (37 days) of daily instillations, more if one decreases the amount instilled or decreases the frequency of treatment.

    For those that are using, what is your compounded ratio? 80 mL gent/100 mL saline is quite a bit stronger than the 48 mL mentioned in the article (480 mL/liter).

    Also, what is your frequency of treatment?

    Lastly, if one has a UTI would it be viable to use this as a form of treatment in place of oral antibiotic, as opposed to prophylactic use. Then one has to deal with, always keeping some on hand and mixing when needed. If using it in this manner, I imagine, one would have to know via the sensitivity report whether the bacteria would be sensitive to gentamicin.

    Thank you.

    You have some errors in this discussion of the amount (mg) of or concentration of (mg/ml) the gentamicin.

    My Dad's urologist prescribes it according to the publication.

    Providers used a compounded formulation of 480 mg gentamicin diluted in 1L normal saline. A gravity instilled dose of 30‒60 ml (14.4‒28.8mg) of the solution is instilled into the bladder (depending on bladder capacity) after drainage of urine is complete at the patient's last evening catheterization and left indwelling until the next catheterization.

    It is 480mg (milligrams) of gentamicin + 1000ml of normal saline. Not 480ml of gentamicin. This makes a solution of 480mg/1000ml or about 0.5mg/ml. Gentamicin comes initially as a powder, which a compounding pharmacy mixes with normal saline to form a liquid solution of gentamicin. It sounds like several on this board receive a concentrated solution of the gentamicin that they then dilute to the final concentration that they use to instill. My Dad receives the Gentamicin already at the concentration that is to be used for instillation. So he just takes 60ml of it and instills. That is 28.8mg of medicine per instillation.

    I think some of the posters who receive gentamicin as a concentrated solution, and then dilute that solution more in normal saline, were using a much higher amount (mg) than my Dad does per instillation. I don't know how their docs came up with that dose.

    My Dad's urologist has patients at several different frequencies of use, depending on their situation. My Dad instills twice a day, and the doctor most commonly has people instilling twice or once a day when they start with this method. If you have good control of UTIs at this frequency, she then suggests decreasing the frequency over time. Like..... after a year or more. It depends. She uses this method for UTI prevention and has not mentioned using it for treatment.
    Last edited by hlh; 03-22-2018 at 12:03 PM.

  3. #43
    This is really not a method used for treatment of a uti, although it may be prescribed at the same time an oral antibiotic is. And while I am thrilled to have the data from the study, I would love to see it replicated with larger numbers. It is certainly helpful and a well done study.
    ckf
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #44
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    I've been battling a ecoli infection for months now being on oral and IV antibiotics. I'm on day 10 of 14 of ertapenem and I can tell I'm not right and will be sick once this is done. I've started Dmannose and apple cider vinegar and probiotics and I showed my uro this same study of gentamicin.

    He he said lets do it and got me somethimg close to Genamicin, it's called Tobramycin. He calls for 2ml of Tobramycin and 20ml of saline and do my flushes like that. Hold it in as long as I can. Does that sounds right to you guys??

    With Orall antibiotics you shouldn't submit a urine sample for 3 days being off them. Will these bladder rinses effect urine test like Oral ab? With vetericyn when I submitted urine it was crystal clear for 2 days then the 3erd it would show all the bugs. With this ecoli it's been showing 12 hours later not days later. I don't know what to do anymore.
    Mark 9:23 - All things are possible for those who believe.

  5. #45
    It is hard to say if the "recipe" is correct since I do not know what the dosage is that is prescribed and how much tobramycin is in each ml. I would go with it since you are having problems and need to start the regimine.

    The bladder rinses should not effect the urine test if you do it enough in advance of the installation that day. You do not want to send a sample that has the tobramycin installation in it.

    ckf
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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