This section advises on the choice of anti-infective agents available at each Trust. Doctors should refer to local or departmental antibiotic guidelines for advice regarding specific treatments within specialised units (including prophylaxis for surgical, medical and dental procedures). Different antibiotic policies can be found in different hospitals due to local variations in resistance and antibiotic susceptibility.
M: Use of this agent only to be initiated under the advice of a microbiologist or virologist as appropriate.
S: Use of this agent only to be initiated under the advice of a relevant clinical specialist.
Dose: 60 mg to 80 mg gentamicin buffered with 0.5 mL of sodium bicarbonate 8.4% to fill the middle ear This procedure is repeated again (at least two hours apart) on the same day. Pretreatment vestibular function testing (caloric testing) must be performed to ensure a normally functioning contralateral labyrinth
Gentamicin injection (off-label use for soaking penile implants)
Approved off-label indication: For soaking penile implants, in combination with rifampicin before insertion
Rifampicin 10 mg/ml and gentamicin 1.2 mg/ml solution made from using 50ml sodium chloride 0.9%, rifampicin 600 mg injection and gentamicin 80 mg injection
Gentamicin injection (off-label use in pacemaker surgery)
Approved off-label indication: Topical use into the pocket during pacemaker surgery
Specialist Prescribing only.
The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist.
In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.
Treatment can be initiated in primary care after a recommendation from an appropriate specialist
Specialist initiation followed by maintenance prescribing in primary care
Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation