What?

A multicentre audit and service evaluation of extended-interval gentamicin prescribing and monitoring (GPM), to assess current practice, audit practice against local policies, and describe clinical outcomes using different strategies in GPM.

 

Why?

Gentamicin is an antibiotic with a wide spectrum of activity versus Gram-negative bacteria, and a rapid bactericidal effect. However, gentamicin has a narrow therapeutic index, with significant risks of nephrotoxicity and ototoxicity.

 

Historically, multiple daily dosing strategies were employed during gentamicin therapy. In the 1990s, ‘extended’ daily dosing regimens replaced mutiple daily dosing, with studies showing comparable effectiveness and reduced nephrotoxicity. A number of different protocols for dosing and monitoring arose simultaneously at different centres. There are very few studies directly comparing these approaches, with no consensus on which one(s) are the most effective, safe and easy to follow.

 

An audit of gentamicin in the northwest of England revealed a wide variety of practice across NHS Trusts, with GPM according to Trusts’ local policies being well below the audit standards. Local variation in practice may contribute to suboptimal GPM; this is compounded by regular rotation of junior doctors, nurses and pharmacists between organisations. There is no clinical guideline for GPM that is widely used in the UK. This national audit seeks to understand current practice and compare clinical outcomes of different protocols for GPM. The results would help to inform the development of a national guideline for gentamicin prescribing.

 

Who?

Any infection doctor, antimicrobial pharmacist or junior doctor or medical student with an interest in infection specialties. Contribution of data will make all investigators eligible for authorship on the manuscript written by the project leads at the end of the audit.

 

When?

Sites will be invited to express interest from November 2020

Please express your interest by emailing interest@gpm.nitcollaborative.org.uk

 

Project lead: Dr Raqib Huq, ST4 Combined Infection Training, Pennine Acute Hospitals NHS Trust

Consultant lead: Dr Suganya Reddy – Consultant Microbiologist, Lancashire Teaching Hospitals NHS Foundation Trust

Pharmacy lead: Mrs Rebecca Clark – Senior Antimicrobal Pharmacist, Lancashire Teaching Hospitals NHS Foundation Trust