E-DERM

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Gentamicin (E-DERM) and other antibacterial drugs, Gentamicin (E-DERM) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Gentamicin (E-DERM) Sulfate Injection, USP is indicated in the treatment of serious infections caused by susceptible strains of the following microorganisms: Pseudomonas aeruginosa, Proteus species (indole-positive and indole-negative), Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter species, and Staphylococcus species (coagulase-positive and coagulase-negative).

Clinical studies have shown Gentamicin (E-DERM) Sulfate Injection, USP to be effective in bacterial neonatal sepsis; bacterial septicemia; and serious bacterial infections of the central nervous system (meningitis), urinary tract, respiratory tract, gastrointestinal tract (including peritonitis), skin, bone and soft tissue (including burns).

Aminoglycosides, including Gentamicin (E-DERM), are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are susceptible to these antibiotics and are not susceptible to antibiotics having less potential for toxicity.

Specimens for bacterial culture should be obtained to isolate and identify causative organisms and to determine their susceptibility to Gentamicin (E-DERM).

Gentamicin (E-DERM) Sulfate may be considered as initial therapy in suspected or confirmed gram-negative infections, and therapy may be instituted before obtaining results of susceptibility testing. The decision to continue therapy with this drug should be based on the results of susceptibility tests, the severity of the infection, and the important additional concepts contained in the box. If the causative organisms are resistant to Gentamicin (E-DERM), other appropriate therapy should be instituted.

In serious infections when the causative organisms are unknown, Gentamicin (E-DERM) Sulfate may be administered as initial therapy in conjunction with a penicillin-type or cephalosporin-type drug before obtaining results of susceptibility testing. If anaerobic organisms are suspected as etiologic agents, consideration should be given to using other suitable antimicrobial therapy in conjunction with Gentamicin (E-DERM). Following identification of the organism and its susceptibility, appropriate antibiotic therapy should then be continued.

Gentamicin (E-DERM) Sulfate has been used effectively in combination with carbenicillin for the treatment of life-threatening infections caused by Pseudomonas aeruginosa. It has also been found effective when used in conjunction with a penicillin-type drug for the treatment of endocarditis caused by group D streptococci.

Gentamicin (E-DERM) Sulfate Injection, USP has also been shown to be effective in the treatment of serious staphylococcal infections. While not the antibiotic of first choice, Gentamicin (E-DERM) may be considered when penicillins or other less potentially toxic drugs are contraindicated and bacterial susceptibility tests and clinical judgment indicate its use. It may also be considered in mixed infections caused by susceptible strains of staphylococci and gram-negative organisms.

In the neonate with suspected bacterial sepsis or staphylococcal pneumonia, a penicillin-type drug is also usually indicated as concomitant therapy with Gentamicin (E-DERM).

Adwizole (Miconazole nitrate (E-DERM) nitrate) Spray is indicated for the treatment of fungal infections in dogs and cats caused by Microsporum canis, Microsporum gypseum and Trichophyton mentagrophytes.

Gentamicin (E-DERM) is an antibiotic. It fights bacteria in the body.

Gentamicin (E-DERM) is used to treat severe or serious bacterial infections.

Gentamicin (E-DERM) may also be used for purposes other than those listed in this medication guide.

Miconazole nitrate (E-DERM) buccal treats fungus (yeast) infections in the mouth and throat (oral thrush). It belongs to the group of medicines called antifungals and works by killing or preventing growth of the fungus or yeast.

Miconazole nitrate (E-DERM) is available only with your doctor's prescription.

Each ampoule is for use in a single patient on 1 occasion only.

Adults: Serious Infections (Systemic and Urinary Tract Infections): 3 mg/kg/day in 3 doses given every 8 hrs.

Life-Threatening Infections: Up to 5 mg/kg/day in 3 or 4 equal doses with reduction to 3 mg/kg/day as soon as clinically indicated. Doses should never exceed 5 mg/kg/day unless serum levels are monitored.

The following table should be used as a guide: See Table 1.

Children: The following table should be used as a guide: See Table 2.

Patients with Renal Impairment: Dosage should be adjusted to minimise the risk of toxicity. The 1st dose should be as normal eg, 80 mg (body weight >60 kg) and subsequent doses should be given less frequently, depending on the degree of renal impairment.

Table 3 should be used as a guide: See Table 3.

When only a serum urea concentration is available, this value may be utilized initially, however, it should be supplemented with a serum creatinine level or creatinine clearance rate whenever possible.

Note: The standard dose of 80 mg 3 times a day may be inappropriate and a more appropriate dose can be calculated using a nomogram which takes into account the patient's serum creatinine levels, body weight and age. This dose can be adjusted if necessary following determination of serum creatinine levels. Desirable serum levels of Gentamicin (E-DERM) are 5-8 mcg/mL as a peak and 1-2 mcg/mL as a trough.

Note: In children with impaired renal function, serum levels should be monitored and frequency of dosage reduced if indicated.

Adults with Renal Failure Undergoing

Haemodialysis:

Administration: Gentamicin (E-DERM) is normally given by IM injection.

Intravenous administration may be used for particular indications when the IM route is not appropriate. The dosage is the same for either route of administration. It is desirable to measure both peak and trough serum levels during treatment. Prior to administration, the patient's body weight should be measured for the correct calculation of dosage. In obese patients, the appropriate dose can be calculated by assuming the body weight is the patient's estimated lean body weight plus 40% of the excess. Blood specimens for the determination of peak Gentamicin (E-DERM) concentrations should be obtained approximately 1 hr following IM administration and 30-min after completion of a 30-min infusion. Blood specimens for the trough Gentamicin (E-DERM) concentration should be obtained immediately prior to the next IM or IV dose.

Intravenous Administration:

Directions for Use: Miconazole nitrate (E-DERM): Clean and thoroughly dry affected area. Apply a thin layer of solution 2-3 times daily. Continue treatment for 2 weeks after symptoms disappear to avoid recurrence.

Nail Infections: Cut nails as short as possible. After the affected nail has come off, continue treatment until the new nail has grown. Cleanse with a soap alternative eg, Pinetarsol as soap may irritate the skin.

Miconazole nitrate (E-DERM) Tinea: Cream: Apply twice daily to infected area and surrounding skin. Regular application is essential for successful treatment. Prevent recurrence by continuing treatment for 2 weeks after condition clears.

Soap should not be used on the affected area as it may irritate the skin, thereby exacerbating the condition and its symptoms. To effectively relieve the itch and irritation associated with fungal infections, use a soap alternative eg, Pinetarsol solution or Pinetarsol gel. These will help maintain the skin's natural acid protection while relieving the itch and reducing inflammation.

Powder: Clean affected area with a soap substitute eg, Pinetarsol gel. Dry thoroughly, puff powder onto affected area twice daily. Dust inside clothing that is in contact with affected area eg, socks and underpants to keep the skin dry and help prevent reinfection. Continue treatment for 2 weeks after symptoms disappear to avoid recurrence.

See also:
What is the most important information I should know about Gentamicin (E-DERM)?

Known hypersensitivity to Gentamicin (E-DERM) or aminoglycosides and/or preserving agents (para group allergy); patients with preexisting vestibular and/or cochlear disease should be given aminoglycosides for life-threatening conditions only.

Administration of other ototoxic and/or nephrotoxic antibiotics together with or immediately after Gentamicin (E-DERM) should be avoided.

Caution should be exercised in patients with reduced renal function to avoid drug cumulation. Caution is also indicated in patients with milder degrees of renal insufficiency, neuromuscular disease (eg, myasthenia gravis or Parkinson's disease) and at an advanced age. As Gentamicin (E-DERM) contains sulfite, it must not be used in asthmatics hypersensitive to sulfite.

Use in pregnancy & lactation: During pregnancy, Gentamicin (E-DERM) should only be given for life-threatening conditions or if other antibiotics are ruled out. As Gentamicin (E-DERM) is known to be present in breast milk, breastfeeding should be suspended if Gentamicin (E-DERM) is administered during lactation.

See also:
What is the most important information I should know about Miconazole nitrate (E-DERM)?

Sensitivity to any ingredients of Miconazole nitrate (E-DERM)/Miconazole nitrate (E-DERM) Tinea.

Use Gentamicin (E-DERM) drops as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Gentamicin (E-DERM) drops is for use in the eye. Avoid contact with other mucous membranes.
• Soft contact lenses may absorb a chemical in Gentamicin (E-DERM) drops. Do not wear contact lenses while you are using Gentamicin (E-DERM) drops. Take care of your contact lenses as directed by the manufacturer. Check with your doctor before you use them.
• To use Gentamicin (E-DERM) drops in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eyelid for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean, dry tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them.
• To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
• To clear up your infection completely, use Gentamicin (E-DERM) drops for the full course of treatment. Keep using it even if you feel better in a few days.
• Using Gentamicin (E-DERM) drops at the same times each day will help you to remember to use it.
• If you miss a dose of Gentamicin (E-DERM) drops, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Gentamicin (E-DERM) drops.

Use Miconazole nitrate (E-DERM) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• An extra patient leaflet is available with Miconazole nitrate (E-DERM). Talk to your pharmacist if you have questions about this information.
• Use Miconazole nitrate (E-DERM) in the morning after you brush your teeth.
• Wash your hands and dry well before handling Miconazole nitrate (E-DERM).
• Place the rounded side of the tablet against the upper gum just above the incisor tooth. Check with your doctor or pharmacist if you are not sure where to place Miconazole nitrate (E-DERM).
• Apply slight pressure over the upper lip to hold the tablet in place for 30 seconds to make sure that it stays in place. The tablet may be used if it sticks to the cheek, the inside of the lip, or the gum.
• After you apply Miconazole nitrate (E-DERM), allow it to dissolve slowly in your mouth. Do not chew, crush, or swallow it whole.
• Apply your next dose to the other side of the mouth. Before you apply your next dose, rinse your mouth to be sure none of the previous tablet still remains.
• You may eat and drink while the tablet is in place. However, do not chew gum while the tablet is in place.
• If the tablet does not stick or falls off within the first 6 hours, replace the same tablet back against the gum immediately. If the tablet still does not stick, remove that tablet and put a new one in place.
• If you accidentally swallow Miconazole nitrate (E-DERM) within the first 6 hours, drink a glass of water. Then put a new tablet in place. The tablet should only be replaced once. Check with your doctor or pharmacist if you accidentally swallow the tablet and you are not sure what to do.
• If the tablet falls off or is accidentally swallowed after it has been in place for 6 hours or more, do not replace that tablet until your next regularly scheduled dose.
• To clear up your infection completely, use Miconazole nitrate (E-DERM) for the full course of treatment. Keep using it even if your condition improves in a few days.
• If you miss a dose of Miconazole nitrate (E-DERM), use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Miconazole nitrate (E-DERM).

This medication is used to treat minor skin infections (such as impetigo, folliculitis) or minor infections related to some skin conditions (such as eczema, psoriasis, minor burns/cuts/wounds). Gentamicin (E-DERM) works by stopping the growth of certain bacteria. It belongs to a class of drugs known as aminoglycoside antibiotics.

This antibiotic only treats bacterial infections. It will not work for virus or fungus infections. Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

How to use Gentamicin (E-DERM) topical

This medication is for use on the skin only.

Wash your hands before using. Clean and dry the affected area as directed. If you are treating impetigo, remove any dried, crusty skin to increase contact between the antibiotic and the infected area. Then gently apply a small amount of medication in a thin layer as directed by your doctor, usually 3 to 4 times a day. You may cover the area with a sterile gauze bandage if so directed. Keep the infected area clean. Wash your hands after use, unless you are using this product to treat the hands.

Avoid getting this medication in your eyes, nose, or mouth. If this occurs, wipe off the medication and rinse thoroughly with water.

Dosage and length of treatment is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day. Do not apply large amounts of this medication, use it more often, or use it for longer than prescribed. Your condition will not improve any faster, and your risk of side effects may increase.

Continue to use this medication for the full length of treatment prescribed, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.

Tell your doctor if your skin infection persists or if it worsens.

Miconazole nitrate (E-DERM) is an imidazole (organic compound) antifungal agent used to treat fungal and associated bacterial super infections of the skin and nails Miconazole nitrate (E-DERM) is also used for oral treatment and prevention of fungal infections of the mouth, throat and food pipe Miconazole nitrate (E-DERM) is effectively used in vulvovaginal (vagina and external genital organs) candidiasis (thrush) and other yeast infection of the vagina. Further, Miconazole nitrate (E-DERM) is also prescribed for napkin rash and inflammation of the folds of tissue surrounding the nails of toes or fingers (paronychia).

See also:
What other drugs will affect Gentamicin (E-DERM)?

Penicillins: Gentamicin (E-DERM) is inactivated by solutions containing β-lactam antibiotics (penicillins and cephalosporins) so the 2 drugs should not be administered simultaneously nor should they be combined in the IV fluid. The inactivation of Gentamicin (E-DERM) by penicillins may occur in vivo, especially in patients with renal failure who maintain a higher level of the penicillin for a longer period of time. Therefore, when Gentamicin (E-DERM) and penicillins are used together in patients with renal failure, the time of administration of each drug should be staggered so that several hours separate each infusion.

Diuretics: Potent diuretics eg, ethacrynic acid or frusemide may potentiate the ototoxic effects of Gentamicin (E-DERM).

Other Neurotoxic and/or Nephrotoxic Agents: Since the ototoxic or nephrotoxic effects of Gentamicin (E-DERM) may be additive, avoid concurrent or sequential use of other neurotoxic and/or nephrotoxic antibiotics, including other aminoglycosides, polymyxin B, colistin, cisplatin, vancomycin, amphotericin, clindamycin and cephalosporins.

Neuromuscular-Blocking Agents: Respiratory paralysis and prolongation of neuromuscular blockade may occur if a neuromuscular-blocking agent eg, suxamethonium (succinylcholine), tubocurarine, decamethonium, halogenated hydrocarbon inhalation anaesthetics, opioid analgesics or massive transfusions with citrated anticoagulated blood are administered to a patient receiving Gentamicin (E-DERM).

Vitamin K: Gentamicin (E-DERM) may inhibit the action of IV vitamin K upon the synthesis of clotting factors.

Potential Interactions: In vitro synergism and antagonism have been found between various antineoplastic agents and aminoglycosides.

Incompatibilities. When Gentamicin (E-DERM) is used in combination with any other drug, mixing the drugs before administration should be avoided at all costs.

See also:
What other drugs will affect Miconazole nitrate (E-DERM)?

Oral anticoagulants, sulfonylurea hypoglycemics, phenytoin, carbamazepine, astemizole, cisapride & terfenadine.

See also:
What are the possible side effects of Gentamicin (E-DERM)?

Nephrotoxicity: Adverse renal effects, as demonstrated by the presence of casts, cells or protein in the urine or by rising BUN, NPN, serum creatinine or oliguria, have been reported. They occur more frequently in patients with a history of renal impairment and in patients treated for longer periods or with larger dosages than recommended.

Neurotoxicity: Serious adverse effects on both vestibular and auditory branches of the eighth nerve have been reported, primarily in patients with renal impairment (especially if dialysis is required) and in patients on high doses and/or prolonged therapy. Symptoms include dizziness, vertigo, tinnitus, roaring in the ears and also hearing loss, which, as with the other aminoglycosides, may be irreversible. Hearing loss is usually manifested initially by diminution of high-tone acuity. Other factors which may increase the risk of toxicity include excessive dosage, dehydration and previous exposure to other ototoxic drugs.

Peripheral neuropathy or encephalopathy, including numbness, skin tingling, muscle twitching, convulsions, and a myasthenia gravis-like syndrome, have been reported.

NOTE: The risk of toxic reactions is low in patients with normal renal function who do not receive Gentamicin (E-DERM) Sulfate at higher doses or for longer periods of time than recommended.

Other reported adverse reactions possibly related to Gentamicin (E-DERM) include: Respiratory depression, lethargy, confusion, depression, visual disturbances, decreased appetite, weight loss and hypotension and hypertension; rash, itching, urticaria, generalized burning, laryngeal edema, anaphylactoid reactions, fever, and headache; nausea, vomiting, increased salivation, and stomatitis; purpura, pseudotumor cerebri, acute organic brain syndrome, pulmonary fibrosis, alopecia, joint pain, transient hepatomegaly and splenomegaly.

Laboratory abnormalities possibly related to Gentamicin (E-DERM) include: Increased levels of serum transaminase (SGOT, SGPT), serum LDH and bilirubin; decreased serum calcium, magnesium, sodium and potassium; anemia, leukopenia, granulocytopenia, transient agranulocytosis, eosinophilia, increased and decreased reticulocyte counts and thrombocytopenia. While clinical laboratory test abnormalities may be isolated findings, they may also be associated with clinically related signs and symptoms. For example, tetany and muscle weakness may be associated with hypomagnesemia, hypocalcemia and hypokalemia.

While local tolerance of Gentamicin (E-DERM) Sulfate is generally excellent, there has been an occasional report of pain at the injection site. Subcutaneous atrophy or fat necrosis suggesting local irritation has been reported rarely.

See also:
What are the possible side effects of Miconazole nitrate (E-DERM)?

Miconazole nitrate (E-DERM) may cause side effects. If you experience any of the following symptoms, call your doctor immediately:

increased burning, itching, or irritation of the skin or vagina.

stomach pain.

fever.

foul-smelling vaginal discharge.

Gentamicin (E-DERM) also contains the following ingredients: Methyl paraben 1.8 mg, propyl paraben 0.2 mg, sodium bisulfite 3.2 mg, disodium ethylenediaminetetraacetate 0.1 mg and water for injection.

Gentamicin (E-DERM) sulfate injection is a sterile solution of Gentamicin (E-DERM) sulfate water for injection. It contains the equivalent of not less than 90% and not more than 125% of the labeled amount of Gentamicin (E-DERM). It may contain suitable buffers, preservatives, sequestering agents, unless it is intended for intrathecal use, in which case it contains only suitable tonicity agents.

Miconazole nitrate (E-DERM): Each mL of solution contains miconazole nitrate nitrate, in a soothing, cooling solution, which helps to keep the infection site dry.

Miconazole nitrate (E-DERM) Tinea: Each gram of cream contains miconazole nitrate nitrate, dimethicone and phenethyl alcohol in a lanolin-free aqueous soft cream base. It has a pH of 5.

Each gram of powder contains miconazole nitrate nitrate in a zinc oxide menthol and talc powder base.

All cream products are lanolin-free, propylene glycol-free, colour-free, perfume-free and paraben-free to avoid irritant reactions.