Pregnancy Medication Consultation: Concerns About V-Genta (Gentamicin) Use

Pregnancy Medication Consultation: v-genta (gentamicin)

Hello Doctor: My wife is currently 35 weeks pregnant and was hospitalized for bed rest.
During this time, she required intravenous infusion, which led to symptoms of phlebitis and cellulitis at the injection site.
The obstetrician's treatment included: *V-genta (gentamicin) 80 mg intravenous injection, administered only once (the exact dosage is uncertain), originally prescribed for two days at two doses each day, but later discovered to be a Category D medication, and we requested to stop it due to concerns about side effects.
*Cephalexin 500 mg, four times a day for seven days, which she is still using.
*Neosporin ointment, applied four times a day, with a gradual reduction to twice a day after seven days.
(Neomycin Sulphate 5 mg, Bacitracin Zinc 400 U, Polymyxin B Sulphate 5000 U) I would like to ask about the likelihood and impact of ototoxic side effects from the single intravenous dose of V-genta (gentamicin).
Are there any precautions we should take in the future? Although my obstetrician mentioned that there would be no effects, I would appreciate your second opinion.
Thank you.

YJ, 30~39 year old female. Ask Date: 2020/11/02

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it generally does not have an impact.
Wishing you good health.

Reply Date: 2020/11/02

More Info

Gentamicin, marketed as V-genta, is an aminoglycoside antibiotic that is often used to treat serious infections caused by certain bacteria. Its use during pregnancy raises concerns due to its classification as a Category D medication by the FDA, indicating that there is positive evidence of human fetal risk, but the benefits may outweigh the risks in certain situations.
In your wife's case, she received a single intravenous dose of gentamicin at 35 weeks of pregnancy. The primary concerns with gentamicin use during pregnancy are its potential ototoxicity (ear toxicity) and nephrotoxicity (kidney toxicity). Ototoxicity can lead to hearing loss or balance issues in the newborn, while nephrotoxicity can affect kidney function. However, the risk of these side effects is generally associated with prolonged use or higher cumulative doses of the medication.

Given that your wife received only one dose, the risk of significant ototoxicity is considerably lower compared to a regimen that involves multiple doses over an extended period. The likelihood of adverse effects, particularly ototoxicity, is dose-dependent, and a single administration is less likely to cause harm. However, it is essential to monitor for any signs of hearing issues or other complications in the newborn after birth.

In terms of follow-up care, it is advisable to keep an open line of communication with your healthcare provider. They may recommend monitoring the baby's hearing and kidney function after birth, especially if there are any concerns. Additionally, if your wife experiences any unusual symptoms or if there are concerns about the injection site (such as increased redness, swelling, or pain), it is crucial to seek medical attention promptly.

Regarding the other medications your wife is taking, Cephalexin is generally considered safe during pregnancy, as it falls under Category B, indicating no evidence of risk in human studies. The topical ointment containing Neomycin, Bacitracin, and Polymyxin B is also commonly used and is generally considered safe for localized treatment.

It is important to note that while your wife's obstetrician has indicated that there should not be any significant impact from the gentamicin, it is always wise to seek a second opinion if you have lingering concerns. Discussing these concerns with a maternal-fetal medicine specialist may provide additional reassurance and guidance tailored to your wife's specific situation.

In summary, while the use of gentamicin during pregnancy is not without risks, the single dose your wife received is unlikely to lead to significant adverse effects. Continuous monitoring and communication with healthcare providers will be key in ensuring both your wife's and the baby's health. Always consult with a healthcare professional before making any decisions regarding medication during pregnancy to ensure the safety and well-being of both mother and child.

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