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new study results on gentamicin instillation and uti prevention

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  • #31
    Does this work for people with suprapubic catheters as well

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    • #32
      Originally posted by yiannit View Post
      Does this work for people with suprapubic catheters as well
      It is unclear whether you are asking about gentamicin or microcyn. But, both can be used with a supra pubic catheter.

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      • #33
        Originally posted by gjnl View Post
        It is unclear whether you are asking about gentamicin or microcyn. But, both can be used with a supra pubic catheter.
        whichever would prevent UTIs, if both are recommended that i'll use both. i'll have to run it by my urologist as well

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        • #34
          This is interesting. In what form is this bought? Is it the same as the intravenous? Obviously we need a prescription, right? Are urologists open to it? I live overseas and only see a US urologist every couple of years or so.
          T6 complete (or so I think), SCI since September 21, 2003

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          • #35
            Maybe these two threads should be merged together since the inquires are so closely linked.


            http:///forum/showthread.php?261642-...uti-prevention
            http:///forum/showthread.php?261977-...nd-Micorcyn-AH

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            • #36
              Originally posted by yiannit View Post
              whichever would prevent UTIs, if both are recommended that i'll use both. i'll have to run it by my urologist as well

              I would not recommend using both, if you don't use both now. Why? It gets expensive and is likely redundant. Start with one.

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              • #37
                Originally posted by paramoto View Post
                This is interesting. In what form is this bought? Is it the same as the intravenous? Obviously we need a prescription, right? Are urologists open to it? I live overseas and only see a US urologist every couple of years or so.
                You should bring a copy of the published paper to your urologist, if they aren't familiar with the Gentamicin instillations. If they aren't familiar with it, honestly they aren't an experienced urologist for those with SCI. But anyway....

                The doctor writes a prescription. Ours prescribes it electronically to a pharmacy that mixes up the antibiotics. So this is not the standard drugstore pharmacy, but the type of pharmacy that provides home infusion or home IV antibiotic products. Ask the doctor which pharmacies they know supply antibiotics in the home, or basically call any hospital pharmacy and ask them what local pharmacies can provide antibiotics like this. It is the same antibiotic you would use for intravenous, but is a different concentration and probably is prepared slightly differently.

                I can't see why a urologist wouldn't be open to it, especially if you are at a major hospital. The benefits are pretty well established now. Where are you overseas? Europe is ahead of us in some SCI things (like using Peristeen) so it wouldn't surprise me if a urologist there might be even more open to it.

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                • #38
                  i get individual 80mg vials and mix enough for a week at a time in 100ml bottles of sterile saline. this way its always fresh. the vials have at least a 1 yr exp date. i get the vials through my regular cvs pharmacy, 90 day supply at a time. the cath tip syringes, regular syringes and 100ml bottles of saline from my urological supplier. all covered under private ins.
                  Originally posted by paramoto View Post
                  This is interesting. In what form is this bought? Is it the same as the intravenous? Obviously we need a prescription, right? Are urologists open to it? I live overseas and only see a US urologist every couple of years or so.
                  Bike-on.com rep
                  John@bike-on.com
                  c4/5 inc funtioning c6. 28 yrs post.
                  sponsored handcycle racer

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                  • #39
                    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.

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                    • #40
                      Originally posted by crags View Post
                      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.
                      This is an abstract of a study done in children using a once daily treatment of gentamicin to treat urinary tract infections (UTI). It appears to be effective in treating a UTI. That said, I wouldn't go down the road of self treating a urinary tract infection. You definitely need a urinalysis (UA) and a culture & sensitivity (C&S) to determine the bacteria and the most effective antibiotic for that bacteria at the incident of that infection. Then after a 12-14 day course of the appropriate antibiotic, you need to retest the urine to make sure there are no latent bacteria left around. If there are latent bacteria, your urologist should treat with another course of the same antibiotic or another one that may attack the bacteria in other ways.

                      I am wondering how much gentamicin might left in/on (half life possibility) the bladder tissues after daily prophylactic instillations that might skew a UA and C&S should you get an infection and need these tests..

                      Treatment of urinary tract infection with gentamicin once or three times daily.

                      Chong CY1, Tan AS, Ng W, Tan-Kendrick A, Balakrishnan A, Chao SM.
                      Author information


                      https://www.ncbi.nlm.nih.gov/pubmed/12725542

                      Abstract

                      AIM:

                      To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI).
                      METHODS:

                      This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg(-1) d(-1) or TDS gentamicin 6 mg kg(-1) d(-1) divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment.
                      RESULTS:

                      210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n = 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n = 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2-3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence.
                      CONCLUSION:

                      OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.


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                      • #41
                        if you get a uti while doing daily gent instills it will be gent resistant.
                        Bike-on.com rep
                        John@bike-on.com
                        c4/5 inc funtioning c6. 28 yrs post.
                        sponsored handcycle racer

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                        • #42
                          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, 12:03 PM.

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                          • #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.

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                            • #44
                              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.

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                              • #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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