Editing Gentamicin (section)

==Medical uses==
Gentamicin is active against a wide range of bacterial infections, mostly Gram-negative bacteria including ''[[Pseudomonas]]'', ''[[Proteus (bacterium)|Proteus]]'', ''[[Escherichia coli]]'', ''[[Klebsiella pneumoniae]]'', ''Enterobacter aerogenes'', ''[[Serratia]]'', and the Gram-positive ''[[Staphylococcus]]''.<ref name="Baxter Corporation">{{Cite web|url = http://www.baxter.ca/en/downloads/product_information/GENTAMICIN(E)_PM_AUG282012_EN.pdf|title = Gentamicin|access-date = 2 November 2015|publisher = Baxter Corporation|url-status = dead|archive-url = https://web.archive.org/web/20160304124731/http://www.baxter.ca/en/downloads/product_information/GENTAMICIN(E)_PM_AUG282012_EN.pdf|archive-date = 4 March 2016}}</ref> Gentamicin is used in the treatment of respiratory tract infections, urinary tract infections, blood, bone and soft tissue infections of these susceptible bacteria.<ref name="Product Monograph">{{Cite web|url = http://www.sandoz.ca/cs/groups/public/@sge_ca/documents/document/n_prod_1301121.pdf|title = Gentamicin Injection USP | work = Product Monograph|access-date = 2 November 2015|publisher = Sandoz Canada Inc|url-status = dead|archive-url = https://web.archive.org/web/20150412102019/http://www.sandoz.ca/cs/groups/public/%40sge_ca/documents/document/n_prod_1301121.pdf|archive-date = 12 April 2015}}</ref>

There is insufficient evidence to support gentamicin as the first line treatment of ''[[Neisseria gonorrhoeae]]'' infection.<ref>{{cite journal | vauthors = Hathorn E, Dhasmana D, Duley L, Ross JD | title = The effectiveness of gentamicin in the treatment of Neisseria gonorrhoeae: a systematic review | journal = Systematic Reviews | volume = 3 | pages = 104 | date = September 2014 | pmid = 25239090 | pmc = 4188483 | doi = 10.1186/2046-4053-3-104 | doi-access = free }}</ref> Gentamicin is not used for ''[[Neisseria meningitidis]]'' or ''[[Legionella pneumophila]]'' bacterial infections (because of the risk of the person going into shock from lipid A [[endotoxin]] found in certain Gram-negative organisms). Gentamicin is also useful against ''[[Yersinia pestis]]'' (responsible for [[Plague (disease)|plague]]), its relatives, and ''[[Francisella tularensis]]'' (the organism responsible for [[tularemia]] often seen in hunters and trappers).<ref>{{cite book| vauthors = Goljan EF |title = Rapid Review Pathology|edition = 3rd|year = 2011|publisher = Elsevier|location = Philadelphia, Pennsylvania|isbn = 978-0-323-08438-3|pages = 241}}</ref>

Some ''[[Enterobacteriaceae]]'', ''[[Pseudomonas]] spp.'', ''[[Enterococcus]] spp.'', ''[[Staphylococcus aureus]]'' and other ''Staphylococcus spp.'' have varying degrees of [[antimicrobial resistance|resistance]] to gentamicin.<ref>{{cite web|title = Gentamicin spectrum of bacterial susceptibility and Resistance|url = http://www.toku-e.com/Upload/Products/PDS/20120604005203.pdf | publisher = TOKU-E |access-date = 15 May 2012|url-status = dead|archive-url = https://web.archive.org/web/20150220033338/http://www.toku-e.com/Upload/Products/PDS/20120604005203.pdf|archive-date = 20 February 2015}}</ref>
===Special populations===
====Pregnancy and breastfeeding====
Gentamicin is not recommended in pregnancy unless the benefits outweigh the risks for the mother. Gentamicin can cross the [[placenta]] and several reports of [[congenital hearing loss|irreversible bilateral congenital deafness]] in children have been seen. [[Intramuscular injection|Intramuscular]] injection of gentamicin in mothers can cause [[muscle weakness]] in the [[newborn]].<ref name="Product Monograph" />

The safety and efficacy for gentamicin in nursing mothers has not been established. Detectable gentamicin levels are found in human breast milk and in nursing babies.<ref name="Product Monograph" />

====Elderly====
In the elderly, [[renal function]] should be assessed before beginning therapy as well as during treatment due to a decline in glomerular filtration rate. Gentamicin levels in the body can remain higher for a longer period of time in this population. Gentamicin should be used cautiously in persons with [[Kidney|renal]], [[Auditory system|auditory]], [[Vestibular system|vestibular]], or [[Neuromuscular junction|neuromuscular]] dysfunction.<ref name="Baxter Corporation" />

====Children====
Gentamicin may not be appropriate to use in children, including babies. Studies have shown higher [[Serum (blood)|serum]] levels and a longer [[half-life]] in this population.<ref>{{cite journal | vauthors = Sato Y | title = Pharmacokinetics of antibiotics in neonates | journal = Acta Paediatrica Japonica | volume = 39 | issue = 1 | pages = 124–131 | date = February 1997 | pmid = 9124044 | doi = 10.1111/j.1442-200X.1997.tb03569.x | s2cid = 23564581 }}</ref> [[Kidney function]] should be checked periodically during therapy. Long-term effects of treatment can include hearing loss and balance problems. [[Hypocalcemia]], [[hypokalemia]], and [[muscle weakness]] have been reported when used by injection.<ref name="Baxter Corporation" />