Gentamicin instillation

[Jeff]

This was suggested by hlh. So, this is for hlh and anyone else who knows.

Sounds like a great idea. I've been reading about it.

Two questions:

Is there a special gentamicin preparation for this?

How often in order to be effective?

Gentamicin is fairly cheap. If I could do this at home I would be all over it. Especially if twice a week or so would be often enough.

[hlh]

My Dad started seeing a new neuro-urologist after a string of 7 UTIs in a row, each one a different bug and getting more resistant. She had a lot of patients with neurogenic bladder, and after he was treated for his last UTI, she started him on the gentamicin instillations twice a day. He hasn't had a UTI since. That was 1.5 years ago.

I believe this is the order she put on a script:

gentamicin 480mg in 1 liter normal saline -Instill 60cc into bladder twice a day.

I suspect the gentamicin is medical grade powder, that they probably dissolve in sterile normal saline.

The local commercial pharmacies (ex. Walgreens, CVS etc..) were not able to prepare it, but some hospital outpatient pharmacies will do it, and we work with Walgreens Home Infusion to supply it. They deliver a fresh batch directly to his house every week. Apparently, once it is dissolved it lasts about two weeks if you keep it in the fridge.

His doctor told him to do the instillations twice a day to start. Usually, she decreases the frequency over time, and most people taper off it and do well. She hasn't had trouble with people developing bad gentamicin resistant infections. She admits is seems like this should be a complication, but she had a theory that the very brief exposure rather than long term exposure of the antibiotic to the bladder was part of the reason resistance didn't develop. Since the gentamicin stays in the bladder, you don't have any of the side effects from the antibiotics affecting your bowels or kidneys.

To do the instillations, get your supplies to do a cath, the gentamicin (which is in the fridge), a clean 60 cc syringe, a clean small beaker/container. Wash your hands and prepare a clean area. Pour 60cc of gent into the beaker, and then pull that into the syringe, and remove air bubbles. Let it warm to room temperature if that is more comfortable to you. Cath as normal. Once done draining, keep the foley in place and grab the syringe and stick it into the funnel end of the foley. Inject the gent into the bladder. Remove the foley. My Dad rolls around a little to distribute the solution in his bladder walls. Leave the Gent in until your next cath. Wash the syringe and small beaker and let air dry.

Some pharmacies will pre-load syringes for you with the Gent, but that is more expensive.

My Dad uses gloves for cathing. He also wipes the tip of his syringe with an alcohol swab before inserting, and sometimes wipes the funnel end of his catheter.

There is no absolute right way to do this.

If others are doing it, post what you are trying.

[Jeff]

I'm not an intermittent cath kind o' guy. I tried getting there... twice, but my bladder is just way too spastic.

I'll have to research this more. I could pull it off once a day, max.

Thanks for taking the time to provide the info!