Dr. Grossan:

I checked and you are right, it is 40 for the whole 500ml container.
Moreover, I was instructed to only use 40ml of it at a time (20 in each
nostril), so that would mean I would only be getting about 3.7 ml of
gentamiacin!

I called the supplier pharmacy, they were very helpful. They said my
doctor ordered the minimum potency.  Their maximum potency is 80ml per
500ml.  They say that their studies have verified this as safe.  This is
closer to your recommendation.  But not really, because they are still
saying to only use 40ml with a syringe to irrigate, which would mean about
7ml gent per irrigation (still not enough).  

I told them that not only would I need a higher potency (their max), but
also a higher dose - not just 40ml but 200 ml per irrigation (a bottle a
day, not a bottle a week) in order to get close to your recommended
dosage, and also for it to be practical to use the irrigator.  They said
they don't mind filling the order but they have to tell the doctor that
that amount has not been tested for safety.  Oy vey!, he probably will
balk at my request.

So you see, not only is this stuff hard to get, it's hard to get the right
amount!  My ENT is in another city.  If he refuses to increase the potency
and quantity, can my regular doctor prescribe it?  He's usually flexible.
Does one have to be an ENT to prescribe this?  

Thank you for this and past generousity with your time.

Joe