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netilmicin (Netromycin)
Tradename: Netromycin.
Indications:
- bacterial infections due to susceptible organisms
- skin infection [4]
- otitis externa
- urinary tract infection
- nosocomial pneumonia
- eye infections
- uveitis
- keratitis
- blepharoconjunctivitis
- corneal abrasion [4]
- empiric treatment of febrile neutropenia
- empiric treatment for fever of unknown origin [4]
Dosage: 4-6.5 mg/kg/day IV/IM divided every 8-12 hours
Monitor:
Therapeutic range:
- Peak: 6-10 ug/mL.
- Trough: 0.5-2 ug/mL.
Dosage adjustment in renal failure:
creatinine clearance dosage
> 50-90 mL/min 50-90% every 8-12 hours
10-50 mL/min* 20-60% every 12 hours
< 10 mL/min 10-20% every 24-48 hours
> 80 mL/min 6.5 mg/kg every 24 hours
60-80 mL/min 5 mg/kg every 24 hours
40-60 mL/min 4 mg/kg every 24 hours
30-40 mL/min 2 mg/kg every 24 hours
20-30 mL/min 3 mg/kg every 48 hours
10-20 mL/min 2.5 mg/kg every 48 hours
< 10 mL/min# 2.0 mg/kg every 48 hours
* same dose for continuous arteriovenous hemofiltration
# 3 mg/kg after hemodialysis
Pharmacokinetics: 1/2life 2-3 hours (35-72 hrs ESRD)
Antimicrobial activity:
Gram positive
- Enterococcus faecalis (synergy with penicillins)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
Gram negative
- Neisseria gonorrhoeae
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia marcescens
- Proteus vulgaris
- Proteus mirabilis [4]
- Pseudomonas aeruginosa
- Providencia [4]
- Citrobacter [4]
Adverse effects:
1) ototoxicity
a) tinnitus
b) vestibular toxicity may occur up to 2-3 months after stopping drug
2) nephrotoxicity
3) therapeutic drug monitoring
Laboratory:
1) specimen:
a) serum, plasma (EDTA)
b) for patients on penicillin, freeze if not analyzed within 4-6 hours
c) peak levels obtained 1 hour after IV/IM dose
2) methods: RIA, MB, HPLC, GLC, REA, EIA, FPIA
3) interferences:
-> MB: coadministration of other antibiotics; penicillins & cephalosporins may be inactivated with commercially available beta lactamase to minimize this interference; heparin may form an inactivating complex with gentamicin
Interactions
drug interactions
drug adverse effects of aminoglycosides
General
aminoglycoside antibiotic
Properties
MISC-INFO: elimination route KIDNEY
1/2life NIL +/- 0.7 HOURS
therapeutic-range 5-10 UG/ML
<4 UG/ML
toxic-range >12 NG/ML
>4 NG/ML
protein-binding <10%
elimination by hemodialysis +
peritoneal dialysis +
pregnancy-category D
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Sanford Guide to antimicrobial therapy 1997, 2001
- Clinical Guide to Laboratory Tests, NW Tietz (ed) 3rd ed,
WB Saunders, Philadelpha 1995
- Deprecated Reference