Update sections 4.4 and 10 as noted below in bold to be in line with EU paediatric regulations.

4.4     Special warnings and special precautions for use

Long-term continuous topical therapy should be avoided.  Prolonged use may lead to skin sensitisation and the emergence of resistant organisms.  Cross sensitivity with other aminoglycoside antibiotics may occur.

In severe infections, topical use of gentamicin should be supplemented with appropriate systemic antibiotic treatment.

Gentamicin may cause irreversible partial or total deafness when given systemically or when applied topically to open wounds or damaged skin.  This effect is dose-related and is enhanced by renal and/or hepatic impairment and is more likely in the elderly.

The condition of the ear drum must always be checked before this medicinal product is prescribed. The medicinal product must not be used if the integrity of the ear drum cannot be guaranteed.

Irreversible toxic effects may result from direct contact of gentamicin with the middle and inner ear. The benefits of gentamicin therapy should be considered against the risk of infection itself causing hearing loss.

Contact lenses should be removed during the period of treatment of ocular infections.

Serious adverse reactions including neurotoxicity, ototoxicity and nephrotoxicity have occurred in patients receiving systemic gentamicin therapy. Although these effects have not been reported following topical otic use of gentamicin, caution is advised when used concomitantly with systemic aminoglycosides.

10    DATE OF (PARTIAL) REVISION OF THE TEXT

December 2010