netilmicin (Netromycin)
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Introduction
Tradename: Netromycin.
Indications
- bacterial infections due to susceptible organisms
- 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
Dosage adjustment in renal failure
Table
| 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)
elimination via kidney
protein binding = <10 %
elimination by hemodialysis = +
elimination by peritoneal dialysis = +
Monitor
Therapeutic range:
Antimicrobial activity
- Enterococcus faecalis (synergy with penicillins)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
- 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
- ototoxicity
- tinnitus
- vestibular toxicity may occur up to 2-3 months after stopping drug
- nephrotoxicity
- therapeutic drug monitoring
Laboratory
- specimen:
- serum, plasma (EDTA)
- for patients on penicillin, freeze if not analyzed within 4-6 hours
- peak levels obtained 1 hour after IV/IM dose
- methods: RIA, MB, HPLC, GLC, REA, EIA, FPIA
- 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
More general terms
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
- ↑ Jump up to: 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Deprecated Reference