Reluctant to use Gentamicin

[KyleP2112]

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:///forum/showthread.php?265264-...-UTI-Infection

[crags]

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.

[beckman]

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

[ChesBay]

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.

[KyleP2112]

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.

[ChesBay]

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 )

[fuentejps]

i do it morning and night

[pete4sake]

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.

[Tman9513]

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

[fuentejps]

cheap ins covers everything..........

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

[crags]

My Medicare part D had it on their formulary and I could get 75 vials for three month supply and the co-pay wasn't bad. All of the other supplies are not covered. This would leave you out of pocket for the cost of needles/syringes (inexpensive), the large piston syringes for the actual instillation, and sterile saline, which will probably be the most expensive part.

For me, it would've been less expensive than using the oculus technology product Hydrocleanse once per day at approximately 45-50 mL per use. That stuff is not cheap.

I would check with your pharmacy provider to see if it covered and then how much it will cost. This will also depend upon how often you do it, once or twice per day. Regardless, one needs to determine the size (ML) and concentration of the vials provided by your pharmacy provider in order to figure out how much that will make and last at your schedule.

[fuentejps]

if u have private ins everything is covered including saline

[KyleP2112]

It is pretty helpful to see how people approach doing gentamicin installation. Hopefully this is effective against increased bacteria levels for using indwelling Foley catheters. I have been using a supra pubic catheter for a while now … Anyone out there know about using gentamicin with a indwelling SP tube?

[beckman]

Here's a link (thanks to annev308) to University of Michigan urology dept instructions for instillation in indwelling catheters
http://www.med.umich.edu/1libr/urolo...Indwelling.pdf

so there must be some support and evidence for using with indwelling catheters