This page follows on from the "Exclusion criteria" statement in the antimicrobial calculators.

Gentamicin:

The following contra-indications and cautions should be taken into account when using the gentamicin calculator.

The gentamicin calculator is not suitable for use in:

Patients with decompensated liver disease - aminoglycosides are associated with an increased risk of renal failure
Concurrent administration of neurotoxic and / or nephrotoxic agents increases the risk of gentamicin toxicity. Review therapy and consider amending or withholding nephrotoxic drugs during gentamicin treatment.

Avoid co-administration with the following:

neuromuscular blockers
other potentially nephrotoxic (e.g. NSAIDs and ACE Inhibitors) or ototoxic drugs
potent diuretics
other aminoglycosides.

This list is not exhaustive – consult www.medicines.org.uk for a full list.

Chronic Kidney Disease (CKD) Stage 4 or more, known or suspected acute kidney injury in the previous 48 hours (³ 50% increase in baseline serum creatinine or oliguria > 6 hours). If gentamicin is clinically indicated, give one dose as per guidance and check with microbiology or an infection specialist before giving a second dose.

The following contra-indications and cautions should be taken into account when using the vancomycin calculator.

To avoid the risk of “red-neck/red-man syndrome”, pain or muscle spasm, ensure that the administration rate is not faster than 500 mg per hour.
Concurrent administration of neurotoxic and / or nephrotoxic agents increases the risk of vancomycin toxicity. Review therapy and consider amending or withholding nephrotoxic drugs during treatment with vancomycin. Where possible, avoid co-administration with the following:
- Amphotericin
- potent diuretics
- aminoglycosides
- NSAIDs
- ACE inhibitors.

The above list is not exhaustive – consult www.medicines.org.uk