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  1. #1
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    Reluctant to use Gentamicin

    After having a bad UTI/bladder infection due to Pseudomonas that required intravenous antibiotics to clear I am reluctant to use Gentamicin flushes. I have read other posts on this forum about Gentamicin but still have some questions about its use and any problems that can develop.
    Can a person develop antibiotic resistance to gentamicin and just develop an infection anyway? What experiences with gentamicin bladder flushes have other people had?

    This thread is from a post I did a few weeks ago about the UTI/bladder infection I had.

    http://sci.rutgers.edu/forum/showthr...-UTI-Infection
    C4/5 incomplete, 17 years since injury

    "The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves happy. The amount of work is the same.” - Carlos Castaneda

    "We live not alone but chained to a creature of a different kingdom: our body." - Marcel Proust

  2. #2
    If one accesses the research papers on the subject, I remember one of them saying that the gentamicin absorption through the bladder wall mucosa is low, thus minimizing the systemic exposure to the gentamicin class of antibiotic and minimizing the chance of broad-based antibiotic resistance to that class. In addition, the research study pointed out that the concentration of gentamicin in the bladder through instillation is much higher than that achieved through oral antibiotic and administration (unsure about IV route), thus making it much more powerful to combat the bacteria. By the time oral antibiotic gets dissolved in the G.I. tract, absorbed into the bloodstream, filtered through the liver and delivered to the bladder circulation, probably much has been cleared through the body. This clearance rate is normal for all antibiotic and is factored in to the dosage and frequency of administration.

    Also, I believe circulation delivered antibiotic is primarily effective at bacteria once they are penetrated the bladder mucosa, which typically results in symptoms of UTI. Instillation delivered antibiotic, which is not heavily absorbed, is more effective at combating the "pool" of circulating pathogens that are always hanging out in the bladder and perhaps sitting on the biofilm of the bladder mucosa. In this case, perhaps a flushing of the area with gentamicin may be more effective than the circulatory route, provided there isn't any mucosal penetration yet resulting in symptoms of UTI.

  3. #3
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    This urologist references a study. She says you don’t have to worry
    https://www.urotoday.com/video-lectu...-17-09-07.html
    excerpt:
    this is the study that was published in the CUAJ. But I do remind people that this is an off-label use of gentamicin bladder irrigations. So, gentamicin is an aminoglycoside antibiotic. And why that's important is that it's a very polar cation. It's not absorbed in the small intestine or the large intestine. It's also not absorbed by the bladder. So if a patient has an augment, a colon augments, a stomach augment, it really doesn't matter. It's still not going to get absorbed through their bladder wall or through their small intestine.

    There have been several studies in children and adults following serum levels of gentamicin, none gets absorbed in the body. So you don't have to worry about antibiotic resistance because resistance develops in the gut. You also don't have to worry about the renal function or their hearing

  4. #4
    Senior Member ChesBay's Avatar
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    Quote Originally Posted by beckman View Post
    This urologist references a study. She says you don’t have to worry
    https://www.urotoday.com/video-lectu...-17-09-07.html
    excerpt:
    this is the study that was published in the CUAJ. But I do remind people that this is an off-label use of gentamicin bladder irrigations. So, gentamicin is an aminoglycoside antibiotic. And why that's important is that it's a very polar cation. It's not absorbed in the small intestine or the large intestine. It's also not absorbed by the bladder. So if a patient has an augment, a colon augments, a stomach augment, it really doesn't matter. It's still not going to get absorbed through their bladder wall or through their small intestine.

    There have been several studies in children and adults following serum levels of gentamicin, none gets absorbed in the body. So you don't have to worry about antibiotic resistance because resistance develops in the gut. You also don't have to worry about the renal function or their hearing
    Kyle, I can understand your concerns, especially if your urologist is not familiar with and a long time prescriber of this treatment. I have been doing installation/irrigation for about 12 years and it has literally changed my life. At about 25 years post SCI I started getting recurring UTIs and this video described , my feelings exactly. It had gotten to where it was not a question of "if" I'd be getting my next infection but 'when'. This method has changed that dramatically. It's a little bit of work but for me, the benefits far outweigh the time needed to do the procedure. Good luck if you try it.

    Beckman & Crags, Excellent video, and info. Some of the best descriptions I have seen and heard. Thanks.

  5. #5
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    These last three posts were really helpful. It makes sense that anabiotic resistance is an a problem with gentamicin installation in the bladder. Just a little wary after having problems with antibiotic resistant bugs.

    Do you use gentamicin once a week or more often? What’s your approach? My urologist recommended once a week.

    Yesterday I got a callback from my urologist with a culture that came back with The bacteria Serratia. I did have some bladder spasms and voiding recently. The urology nurse said it was hard to tell if the bacteria was just a colonizing bacteria and not really a UTI/ bladder infection. They recommended doing gentamicin installation once a day for a week to see if symptoms go away.
    C4/5 incomplete, 17 years since injury

    "The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves happy. The amount of work is the same.” - Carlos Castaneda

    "We live not alone but chained to a creature of a different kingdom: our body." - Marcel Proust

  6. #6
    Senior Member ChesBay's Avatar
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    I do it every night. I cath before going to bed and instill 50-60 cc’s . In the morning I cath it out with my first cath of the day.
    ( I wear a leg bag at night and my bladder kicks off at about 300 cc’s )

  7. #7
    i do it morning and night
    Bike-on.com rep
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  8. #8
    I also do it 2X a day total game changer for me went from 15 UTI's a year to having 1 mild one in the 3+ years I have been instilling... You are right to research all aspects as did I before starting.

  9. #9
    How expensive is it to keep a 2X day regimen?

  10. #10
    cheap ins covers everything..........
    Quote Originally Posted by Tman9513 View Post
    How expensive is it to keep a 2X day regimen?
    Bike-on.com rep
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    c4/5 inc funtioning c6. 28 yrs post.
    sponsored handcycle racer

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