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Thread: Intravesical gentamicin is a winner

  1. #11
    Is it kept in the refrigerator after mixing, and if so does instilling a cold solution cause significant bladder spasm?

  2. #12
    no, i just mix a weeks worth and keep in bathroom
    Quote Originally Posted by crags View Post
    Is it kept in the refrigerator after mixing, and if so does instilling a cold solution cause significant bladder spasm?
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  3. #13
    I'm on Social Security disability and regular Medicare with a Medigap policy. I have a separate part D drug plan through AARP. I just checked and they cover gentamicin sulfate 2 ml (40 mg gent) vials, 25 miles/pkg.

    One can get a 90 day supply (that they define as 90 day) of 75 vials for $27 34. Not bad.

    I will have to calculate to see if their 90 day would conform to my 90 day at what schedule, every day, every other day, etc.

    I buy saline and syringes anyway out-of-pocket so that will be an issue. I also can probably stop buying hydrocleanse, which is currently running me $183 for a two month supply. I do it every day. The gent would actually be cheaper. I can't see doing both.

  4. #14
    Just did some calculations according to what I can get and came up with the following:

    each 2ml vial contains 40mg gent (my pharmacy only offers this size)

    I can get 75 vials or 150ml or 3000 mg gent for a 90 day supply

    mixing 480mg/liter saline would give me 6.25 (6250/480) liters of compounded solution (6250 ml)

    if one instills 30 mL that would give me 208 instillations, more than enough for an every day schedule for 90 days, easily enough for an every other day schedule.

    For those that have done it, do these calculations seem correct? If so, I don't even think I would need to get that much prescribed for a 90 day schedule.

  5. #15
    Quote Originally Posted by crags View Post
    Just did some calculations according to what I can get and came up with the following:

    each 2ml vial contains 40mg gent (my pharmacy only offers this size)

    I can get 75 vials or 150ml or 3000 mg gent for a 90 day supply

    mixing 480mg/liter saline would give me 6.25 (6250/480) liters of compounded solution (6250 ml)

    if one instills 30 mL that would give me 208 instillations, more than enough for an every day schedule for 90 days, easily enough for an every other day schedule.

    For those that have done it, do these calculations seem correct? If so, I don't even think I would need to get that much prescribed for a 90 day schedule.
    i do a higher concentration. that pic is per day. 50ml morning and night. so i mix 3 vials of gent to 100ml saline daily.
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  6. #16
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    Quote Originally Posted by crags View Post
    Is it kept in the refrigerator after mixing, and if so does instilling a cold solution cause significant bladder spasm?
    Yeah it can for me. I draw one dose into a syringe first thing in the morning and leave it covered by the toilet for when I Cath after breakfast. It's room temp by then.
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  7. #17
    Quote Originally Posted by fuentejps View Post
    i do a higher concentration. that pic is per day. 50ml morning and night. so i mix 3 vials of gent to 100ml saline daily.
    What is your vial size and mg/vial? My plan provides 2ml vial containing 40 mg gent.

    Are there recommendations for concentration in the literature?

  8. #18
    Quote Originally Posted by crags View Post
    What is your vial size and mg/vial? My plan provides 2ml vial containing 40 mg gent.

    Are there recommendations for concentration in the literature?
    Here are instructions for Gentamicin dilution and instillation from Seattle Children's Hospital: https://www.seattlechildrens.org/pdf/PE1769.pdf

    Gentamicin Bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798439/

    Providers used a compounded formulation of 480 mg gentamicin diluted in 1 L normal saline. A gravity instilled dose of 30–60 ml (14.4–28.8 mg) 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.

  9. #19
    verify if its 40mg per 1 ml. that would be 80mg per vial
    Quote Originally Posted by crags View Post
    What is your vial size and mg/vial? My plan provides 2ml vial containing 40 mg gent.

    Are there recommendations for concentration in the literature?
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  10. #20
    Anyone using gentamicin to help prevent urinary tract infections have a supra pubic catheter to manage their bladders? Seems the protocol in these studies and trials is to instill diluted gentamicin into the bladder after an intermittent catheterization and leave it in until the next catheterization. If you use a supra pubic catheter, you can clamp or plug the catheter to hold the mixture in the bladder for a while, but it would be impractical and according to our SCI nurses, harmful to plug the catheter for long periods of time. Has anyone seen any information on the minimum amount of time gentamicin should remain in the bladder and still help prevent infections?

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