Instructions to patients using nebulised Gentamicin

Who is the leaflet for? What is its aim?

This leaflet is designed to provide a reference for those who have been advised to use nebulised Gentamicin. Please retain this information for future reference.

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.

Are there any side effects?

Some people may have a reaction to taking the antibiotic which is why you will have had an assessment prior to starting the nebulised Gentamicin at home. If you develop any side effects whilst taking the drug at home you should inform your GP. 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 adsorbed 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. As such any necessary monitoring for these potential side effects will be organised by your GP.

How long will I have to take the antibiotic?

If the antibiotic does not cause side effects, your consultant may want to continue it for at least a year and perhaps indefinitely. Further sputum testing may be done to see if the infection is still present. It may not be completely cleared.

Are there any procedures I need to do prior to treatment?

You should attempt to clear your lungs of sputum prior to taking the nebulised antibiotic. If you have never been shown any techniques or you feel that you are struggling to clear your sputum then please ask your consultant about a referral to a respiratory physiotherapist.

Equipment needed:

There is no commercially available gentamicin nebuliser solution. Doses should be prepared from gentamicin 80mg/2ml solution for injection as below. This is an unlicensed used.

5ml syringe

Sterile needle to draw up medication (Blunt needle if possible)

1ml sterile 0.9% saline solution (from a 5ml vial)

1 vial of Gentamicin (80mg in 2mls)

Procedure (this will be demonstrated during the assessment session)

1. Please take 2 Puffs of your blue inhaler 10 minutes prior to taking Gentamicin

- If you do not have a blue inhaler at home then please use 2.5mg nebule of salbutamol prior to Gentamicin

2. Use the syringe to draw up 1ml of sterile saline.

2. Into the same syringe, draw up 2mls of Gentamicin (total volume in syringe = 3mls).

3. Gently squirt into the nebuliser chamber

4. To prevent the escape of antibiotics into the surrounding environment, attach the filter housing with the filter pad to the outflow tract of the nebuliser.

5. Attach the nebuliser to the compressor with the tubing and switch on. Hold the nebuliser unit level and breathe normally in and out through the mouthpiece. This will take approximately 5 to 15 minutes.

6. When the nebuliser has finished, take it apart, dispose of the filter pad, and wash the remaining parts in hot soapy water and rinse. Leave the parts on kitchen
paper to dry. Re-assemble the nebuliser immediately prior to your next use.

Is there any special care for this equipment?

The nebuliser chamber should be washed in hot soapy water after use and allowed to dry before reassembling. If you are using the filters then these should be discarded after each use. Alternatively, you may vent the exhaled air outside via tubing. You will be shown how to do this at your initial assessment.

Once at home you will need to get a repeat prescription from your GP for the Gentamicin and sodium chloride. The nebuliser chamber should be sterilised once a week to help prevent infection. Place all parts in a saucepan with a few drops of washing up liquid and then boil for ten minutes as per the manufacturer’s recommendations. The nebuliser chamber should last for a year if it is cleaned as instructed.

Who will monitor my treatment/progress?

The consultant who prescribed this treatment will monitor your progress. Your GP will monitor your general health, report any adverse reactions that may occur and provide further prescriptions of Gentamicin, sodium chloride and syringes etc.