What is gentamicin?
Gentamicin is an antibiotic. You are taking it as a nebulised solution straight into your lungs in an attempt to control bacteria found to be growing in your sputum. This may help to reduce the number of chest infections you develop. This leaflet tells you how to prepare and use nebulised gentamicin.
What is a nebuliser?
Nebulisers are machines used to turn medicines into a fine mist which can be inhaled into your lungs. This means your medicine is acting directly in your lungs at the source of the problem.
This treatment is prescribed to be taken once or twice a day, closely after your chest clearance breathing exercises. This means your lungs are most likely to be clear of sputum, which gives the gentamicin its best chance of working effectively.
Your first dose of this medication will be given under supervision by the respiratory nursing team in a face to face clinic setting at the hospital. This is because gentamicin can in some cases irritate the lungs and cause chest tightness. This is a trial to ensure you are suitable to use this medication long term at home safely. Please note if you become very wheezy and tight chested at home, you should stop the nebuliser immediately, take your salbutamol inhaler/nebuliser and if there is no improvement call 999 for an ambulance.
The information in this leaflet will help remind you how to set up your nebulised gentamicin, so you can have treatment at home.
Equipment needed
There is no commercially available gentamicin nebuliser solution. Doses should be prepared from gentamicin 80 mg/2 mL solution for injection as below. This is an unlicensed use of the medication which has been advised and approved by your doctor.
- Gentamicin vial(s) (80 mg in 2 mLs)
- Sodium Chloride 0.9% (saline) ampoules
- 5 mL -10 mL syringe to measure the sodium chloride 0.9%
- Nebuliser machine, tubing and Pari-Neb mouth piece
- Sterile needle to draw up the medication
- Yellow sharps bin
How to prepare gentamicin
Before you start, please note that gentamicin should be nebulised in a well ventilated room without any other people or pets present where possible.
Instructions
- Wash your hands with soap and water; dry them with a clean towel.
- Assemble all necessary equipment.
- Check your gentamicin ampoule and sodium chloride (saline) ampoules are in date.
- Ensure your mouth piece is fitted together as you were shown (photo below), a new clean cotton filter should be used every 24 hours, and tubing connected from the mouth piece to the machine.
- Use the syringe to draw up 1 mL of sterile saline.
- Break the top off the gentamicin ampoule with a firm, snapping motion.
- Into the same syringe, draw up 2 mLs of gentamicin (total volume in the syringe = 3 mLs). You can also add each component separately into the nebuliser chamber if you wish.
- Gently squirt into the nebuliser chamber.
- Do not put the gentamicin into the nebuliser chamber until just before you are going to take it as these medications do not contain preservatives. Keep your nebuliser upright. Do not add any other medication to the chamber with the gentamicin solution.
- Place the mouthpiece into your mouth, turn on your machine, and take normal steady breaths for about 10 minutes, or until all of the vapour has finished. When using your nebuliser you should sit up straight. Do not talk while you are using your nebuliser.
- Vent the air that you have breathed out outside through a tube (this will be shown to you at your appointment).
- Rinse your mouth thoroughly with water (and spit) after taking your nebulised gentamicin in order to prevent a mouth infection or a sore throat developing.
- When you have finished taking your nebuliser dose follow the instructions of how I should care for my nebuliser.
Other Useful Information
Side effects of gentamicin
Sometimes nebulised gentamicin can lead to unwanted side effects, such as:
- coughing
- bronchospasm (a tight feeling in your chest)
- wheezing
- a sore throat or mouth
- a hoarse voice
- nausea (feeling sick)
- a change to your sense of taste
- hearing loss
- harm to your kidneys
If you develop a tight chest, wheeze or difficulty breathing then take your usual Ventolin (salbutamol) and contact your GP urgently. If your condition does not improve with salbutamol, go to the Accident and Emergency Department at your local hospital.
The nebulised antibiotic is poorly absorbed through the lung into the bloodstream and therefore will not affect any other medication taken.
Whilst levels reaching the bloodstream are low, in some cases this can cause adverse effects including ototoxicity (including tinnitus and hearing loss) and impaired kidney function. If you notice new and persistent tinnitus or hearing loss while taking the medication, you should stop taking it and let your medical team know.
How should I care for my nebuliser?
You have been given your own mouth piece and tubing. To keep your nebuliser working properly and prevent infection, the nebuliser chamber (mouth piece equipment) should be emptied after each use and washed in warm water with a little washing up liquid, then rinsed with clear water. Leave to dry naturally on a clean towel or kitchen roll.
Once a week you should boil the Pari-Neb nebuliser chamber in a pan of water, with 2 – 3 drops of washing up liquid added, for 6 – 10 minutes, then rinse with clear water. Alternatively you can make up a sterilisation solution (such as Milton) and follow the manufacturer guidelines on sterilisation. The white cotton filter should be discarded every 24hours. The filter can be used twice only, and must be dried between each use.
Further Supplies
Your gentamicin ampoules and sodium chloride 0.9% ampoules cannot be refilled on repeat prescription from your GP. Please obtain further supplies directly from your respiratory team at the hospital. Cotton filters can be requested from the Respiratory Nursing team as per contact numbers below. You will need to collect these from hospital yourself. Your Pari-Neb mouth piece will last for 1 year, please contact the respiratory nurses for a replacement after that time.
Contact numbers
- Bedford Respiratory Team – 01234 795859
- Luton Respiratory Team – 01582 497483