| المستخلص: |
The aim of this study was to compare transient side effects of rapid bolus intravenous administration of high dose gentamicin over 3 minutes with conventional administration of gentamicin 1mg/ml solution over 30 minutes. Current recommendations suggest that administration of gentamicin doses up to 240mg be administered as IV bolus over 3-5 minutes while doses greater than 240mg have to be diluted and infused over 20-120 minutes. Transiently high gentamicin concentrations after bolus doses are not associated with nephrotoxicity and ototoxicity. Bolus administration provides advantages such as, improved clinical efficacy, savings in cost and time and patient convenience. Consenting patients receiving gentamicin therapy on at least two occasions randomly received one dose as an IV bolus of the undiluted injection solution over 3 minutes, and on the subsequent occasion as a 1mg/ml infusion solution over 30 minutes in a randomised cross-over design with patients acting as their own controls. Patients were assessed at the beginning of the dose, then at 0 (completion of bolus dose), 15, 30 and 60 minutes. Patients were asked if they were experiencing any ringing in their ears, dizziness, headache, nausea or injection site symptoms (pain, redness or swelling at the injection site). They were asked to rate these symptoms from 0 (no effect) to 10 (worst effect). Twenty-six patients were studied, 18 were male and 8 were female. 24 patients received at least one additional antibiotic to gentamicin. The mean administration rate in the bolus arm was 113±19.7 mg/min (range: 80 mg/min to 160mg/min) and 11.4±1.9mg/min (range: 6mg/min to 15 mg/min) in the infusion arm. The most common side–effects occurred immediately post–dose in both phases was injection site pain (bolus arm 35%, infusion arm 8%, P: 0.039) (Fisher’s test). At 15 minutes post-dose and thereafter the difference was absent (bolus 4%, infusion 4%, P=NS). Patients noted a transient sensation (coldness) during bolus administration. No differences in tinnitus, dizziness, headache or nausea were noted at any point. Bolus administration of IV gentamicin over 3 minutes appears to be a valid option instead of infusion over 30 minutes.
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