Gentamicin for nebulization guidance & experiences please!!

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PiddlePod

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Hey everyone, sorry to repost this again but hoping for some info on nebulizing Gentamicin if anyone has experience with this. I'm hoping to try it with Beans to see if we can shrink down some of his pulmonary abscesses or keep them stable for a while longer after the 14 day treatment. I'm still waiting to hear back from Beans' exotics vet to see if they will finally give us the the OK to try the injectable gentamicin but I'm not sure if they're going to be wishy-washy again and tell me no. o_O Hopefully I get a call in the next hour or two so that I can drive over there to pick it up today. Fingers crossed!

I also found a sterlie compounding Pharmacy called Pharmacy Innovations in Erie PA that said they can compound a sterlie Gentamicin solution specifically for nebulization. This will make the particle size a little finer so that the medicine has an easier time reaching the lower lobes of the lung. This gives me a second option to try besides the straight injectable mixed in sterlie saline if our exotics vet gives us the OK to try gentamicin.

As far as dosage I don't know what the vet will prescribe but I did see a suggestion on the ratguide website for nebulizing injectable Gentamicin: 0.5ml of injectable gentamicin 100 mg/ml added to 8 ml of sterlie saline (I will use a 4ml ampoule of Albuterol sulfate/saline and a 4 ml ampoule of the 3% hypertonic saline). Has anyone used this specific solution from the ratguide or has anyone tried a different ratio/mix? Is it safe to nebulize with this stuff for over the prescribed 14 days or restart the therapy again if symptoms return later?

PLEASE if anyone has any experience with this medication for nebulization, dosages and frequency or side effects please share! Thank you all so very much!! ♥️:):D
 
So the vet OKed my gentamicin request! Whoo hoo! I picked up the gentamicin 100 mg/ml today and gave Beans his first nebulizing treatment w/ it per the vet instructions. The vet has the dosage per these instructions: add 0.25ml of gentamicin to a mix of 3 ml Albuterol sulfate and 1.5 ml of 3% hypertonic saline and nebulize for 15-20 minutes twice daily.

The ratguide says add 0.5ml of gentamicin 100 mg/ml to 8ml of saline... So I'm assuming that the vet has cut the dosage since we are using 4.5ml of saline as opposed to the ratguide suggestion of 8ml of saline...am I assuming correctly?

Is there anyone w/ experience that can offer any guidance on this? I want to make sure that Beans gets the correct ratio for proper treatment! Please let me know!
 
You will be the one to teach us. I don't think too many people do the nebulizing. I did know of a lady, many many years ago have success with gentamicin. Keep us posted!
 
I'll share what I find here for sure! First two nebulizing treatments went really well at the dosage my vet gave me for the solution (2.5ml Gentamicin 100 mg/ml, 3ml Albuterol sulfate and 1.5 ml 3% hypertonic saline).

It took about 15 minutes nebulizing the 7 ml of solution, so far so good. No side effects noticed and have been making sure to give Beans some little extra hydration in between treatments w/o interfering with balancing his lasix.

What else... details: I'm nebulizing in a 24 qt Sterlite bin and I'm using a Phillips Respironics Sidestream Plus nebulizer (2.7-4.8 particle size) w/ a PARI VIOS air compressor (green). I have two other nebulizer cups that I've used to nebulize the injectable baytril: a PARI Sprint and PARI Star... different particle sizes for each and the Sprint has a faster delivery. I've used the Sprint exclusively with the injectable baytril but I think for the gentamicin I will stick with the Phillips Respironics since it can nebulize the medication at a smaller particle size (gentamicin has a larger particle). The Phillips Respironics takes a little longer to clear all the medication from the cup by about 4 additional minutes for a total of 19 minutes treatment time; the PARI Sprint is a 12 - 15 minute treatment to clear the cup of 8 ml of solution and the PARI Star is close to a full 20-25 minutes for 8ml of solution (too long IMO).

I also found some documentation on nebulizing Gentamicin for humans that has some instructions on administering it...including mention that if you have pets or other people around that you need to use a special filter end on the nebulizer cup to prevent others from breathing the medication since it is Gentamicin. :eek: I found some solutions such as using a drape of a cut-to-fit filter for HVAC receiver vents as an option (just bought some from Amazon yesterday) to add to the rim of the chamber to catch escaping vapor...or a simpler solution is to just close the door to keep other pets out and wear a mask (we used the 3M brand, N95 respirator w/ valve for yesterday evening treatment and this mornings treatment) during treatment. Which ever method one chooses, it's incredibly important that you don't breathe the vapor that escapes the nebulizing chamber. If anyone is interested in this document I can post a link.

I'll make sure to post here with more info as we treat into the next two weeks. :)

If anyone is interested in more information on the nebulizer cups or compressor, please let me know and I can post links to where I bought these things.

Please do share experiences with this drug if anyone does have guidance or advice! :)
 
I figured I'd go ahead and post the link to the documentation on nebulizing gentamicin along with links to the nebulizers I mentioned and the other items for reference in case anyone is searching on this for their ratties.

As mentioned I use a 24Qt Sterlite Bin + top w/ latches as the nebulizing chamber. I do not have any ventilation holes or meshing installed on the bin; the only hole is at the face of the bin and is cut to fit the nose of the nebulizer. The bin isn't air tight and the fitting between the lid and lip of the bin leaves enough space for air to circulate while allowing the medicine vapor to build up in the bin at the correct concentration. With this set up there will be some vapor seen escaping from under/around the lid.

Here is the bin that I use: https://www.homedepot.com/p/Sterilite-25-Qt-Latching-Storage-Box-14958006/206721478

The only items I have in the bin are a folded medium sized hand towel and a small cardboard box for Beans to hunker down in. Since the box is cardboard I have to toss it every 4th treatment and replace it since the humidity from the vapor tends to make it funky and wash the towel every 4th treatment. I also make sure to wash the entire bin out/scrub it once a week since there can be some buildup of medication on the interior surfaces. Always keep the bin open to air it out between treatments.

Below are the nebulizers I have used w/ injectable enrofloxicin and gentamicin. I prefer the Philips Respironics SideStream Plus nebulizer for Gentamicin. The Respironics Sidestream Plus is made for patients with smaller airways and/or difficulty taking deeper breathes such as infants, the elderly or patients w/ lung disorders (as is the PARI LC Star). The SideStream Plus nebulizer IMO is perfect for rats and I highly recommend it. The second nebulizer I would strongly recommend is the PARI LC Star. The Star has a longer treatment time than the Sprint or Sidestream Plus. Both the PARI LC Star and Respironics Sidestream Plus are able to produce a finer particle size which is further enhanced when a volume greater than 5ml of solution is added to the cup.

The manufacturer websites over estimate the overall MDM (mass median diameter), FPF (fine particle fraction) and the FPD (fine particle diameter) on their websites/product manuals, so the data below is pulled from medical documentation and studies with the accurate numbers/measurements.

Always rinse out the nebulizer cup and mouthpiece with hot water after use. I use F10 to disinfect the nebulizer between uses and I sanitize it every 3 days in boiling water for 5 minutes. The PARI LC Sprint has a blue silicone tongue on the inside of the screw top that will need to be removed or folded back into an open position so that the vapor flows freely into the nebulizing chamber. The Phillips Respironics Sidestream Plus also has a "breath control" stopper that you will need to remove so that the vapor will pass through the nose of the nebulizer w/o requiring the act of inhaling to draw back the silicone flap. The stopper on the Respironics Sidestream Plus (it's a clear strip of silicone in the shape of a rectangle and is positioned on the top of the screw cap/mouth piece) is easy to pull out from the top. Once you can get a hold of the silicone with your nail it should just pop out pretty easily (it looks like a flap when it's removed). These nebulizers work with the patients breathing; the silicone stopper drops down when the user inhales which releases more medication during inhalation. Removing or folding back the stopper eliminates the "breath control" feature so that the vapor will continuously flow. Removing it isn't necessary because the vapor will still flow into the chamber, it just takes more time to complete a treatment and will push the treatment time beyond 25 minutes.

*Phillips Respironics SideStream Plus:
https://www.vitalitymedical.com/respironics-sidestream-plus-nebulizer.html
Output rate: 500 mg/min
MDM (mass Median diameter): 2.1 - 5 um particle size
FPF (fine particle fraction): 76.2
FPD (Fine particle dose): 402 meaning that the finer particles are nebulized per mg/minute with a total of 402mg/min as the amount that actually reaches the deeper areas of the lungs instead of getting stuck in the nose/mouth and upper respiratory tract.

PARI LC Sprint:
https://www.vitalitymedical.com/pari-lc-sprint-nebulizer.html
Output rate: 500mg/min
MMD: 3.5 - 5 um particle size
FPF: 68.72
FPD: couldn't find this information but I will update when I do.

PARI LC Star:
https://www.vitalitymedical.com/pari-lc-sprint-nebulizer.html
Output rate: 400 mg/min
MMD 3.1 - 5 um
FPF: 75.6
FPD: 298

The compressor I currently use is the PARI VIOS Green. I did order a new compressor by PARI called the VIOS Pro which has a Higher operating pressure (Pro is 23.2 Psi vs VIOS Green which has 18 psi) and is a better option if you're using the compressor more than once a day.

Another important thing to remember is after the nebulizing treatment is finished and the nebulizer cup is disconnected from the tubing, the compressor should be turned back on to run air through the tubing. There can be some condensation in the tubing after a treatment and running the compressor for 8 minutes will push the condensation out and dry the line. Forgetting to do this the end of every treatment will leave condensation in the tubing/line that could contribute to bacteria and mold growth that can unintentionally be nebulized and cause serious lung infections. It's always a good idea to replace the tubing, compressor filter and nebulizers every 6 months.

PERI VIOS Pro:
https://justnebulizers.com/products/pari-vios®-pro-nebulizer-compressor?gclid=EAIaIQobChMI2syyzPjG5QIVTRitBh3XBQqlEAQYBSABEgIpj_D_BwE

PARI VIOS Green: https://justnebulizers.com/products/pari-vios?_pos=9&_sid=987b8eda7&_ss=r

In regards to keeping yourself, family members and other pets safe during treatment I would recommend a cut to fit filter that can be fitted along the rim of the sterlite bin chamber or draped over the bin and secured w/ the bin lid. Another option is keeping door closed in the room that you are nebulizing in and wear a 3M N95 respirator mask (simple face mask, nothing crazy).

Here is the cut to fit filter I purchased:
https://www.amazon.com/Ventilaider-...words=cut+to+fit+filter&qid=1572526111&sr=8-6

3M N95 respirator mask: https://www.amazon.com/3M-8511PB1-Particulate-Respirator-10-Pack/dp/B0002YKBV2

Here is the documentation on gentamicin and the use of a filter to prevent inhalation by pets and other people that may be in the room during treatment:
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.nationaljewish.org/NJH/media/pdf/MF-Using-A-Pari-LC-Plus-Nebulizer-with-Gentamicin.pdf?ext=.pdf&ved=2ahUKEwjfmvOr88blAhXwqlkKHY01DYEQFjAPegQIBxAB&usg=AOvVaw0IMW6bR3GCetZx5gLLA1qo&cshid=1572538837572

I think that about covers everything that folks would be interested in if they're searching for information on nebulizing Gentamicin. :)
 
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Update on the Gentamicin-- it's only been two full treatments and tonight will make 2.5 in total. It may be too soon to celebrate but from my observations of his breathing and listening to his lung sounds w/ a stethoscope, his respiratory rate is much better than it was on Wednesday and I can hear clearer air sounds in the left lung (always the worse side) and clearer breath sounds w/ less whooping/congestion on the right side.

So far so good! I'm hoping that our little Beans continues to improve as the week progresses. Please send positive vibes for our little guy! ❤️
 
*happy dance* We are officially on day 3.5 and this evening I've noticed significant improvement in Beans which is so awesome! ❤️❤️❤️ The new VIOS Pro compressor arrived yesterday which is great since I will be able to use it for the next 11 days of treatment. It's more powerful and I like that it's power pressure is 21 psi which is better suited to creating and maintaining a finer particle size during the full 15 minutes of treatment. Hooray!

So Beans is still a little wheezy when listening via the rat phone but I can actually hear air moving in and out of his lungs when he inhales and exhales and the breath sounds are clearer on both sides! Before the Gentamicin his right side was beginning to have consolidation and it was sounding as terrible as his left side.

Hopefully I continue to see improvement as we near the end of the first full week of treatment. I really wish that this stuff could actually "cure" him, unfortunately that isn't the case but I will gladly accept that this treatment is benefiting him by giving him clearer lungs and improved respiratory rate, even if it is just for a couple of months. :) I'm so happy for my little cutie! I'll continue to update as we go and hopefully this thread will be useful to others in the future ❤️
 
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