Netilmicin

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Netilmicin is a member of the aminoglycoside family of antibiotics. These antibiotics have the ability to kill a wide variety of bacteria. Netilmicin is not absorbed from the gut and is therefore only given by injection or infusion. It is only used in the treatment of serious infections particularly those resistant to gentamicin.

Category

Aminoglycoside

US Brand Names

NETROMYCIN® (DISCONTINUED)

Prescribing Information

Contraindications

Warnings and Precautions

  • Pre-existing renal, vestibular, or auditory impairment
  • Concomitant neurotoxic, ototoxic, or nephrotoxic drugs, age (very young/very old), and dehydration; risk factors for toxicity

Pregnancy Category: D

Breast Feeding
  • Infant risk cannot be ruled out.

Adverse Reactions

  • Neurologic: Neuromuscular blockade finding
  • Otic: Ototoxicity
  • Renal: Nephrotoxicity
  • Respiratory: Respiratory tract paralysis, Concomitant anesthesia, muscle relaxants

Dosage and Administration

Intravenous
  • Adults: dilute dose in 50 to 200 mL NS or D5W; infuse over one-half to 2 h.
Dose may be injected directly into vein or IV tubing over 3 to 5 min.
Adult
  • Disease due to Gram-negative bacteria, Susceptible infections due to Pseudomonas and other gram-negative organisms: non-life-threatening infections, 4 to 6 mg/kg/day IV or IM in three equal doses every 8 hours, two equal doses every 12 hours, or once daily for 7 to 14 days.
  • Disease due to Gram-negative bacteria, Susceptible infections due to Pseudomonas and other gram-negative organisms: life-threatening infections, up to 7.5 mg/kg/day IV or IM in three equal doses administered every 8 hours; reduce dose to 6 mg/kg/day or less as soon as clinically indicated.
  • Gonorrhea: 300 mg single IM dose; adjust dose using lean body weight for small or large patients.
  • Infection of skin AND/OR subcutaneous tissue: non-life-threatening infections, 4 to 6 mg/kg/day IV or IM in three equal doses every 8 hours, two equal doses every 12 hours, or once daily for 7 to 14 days.
  • Infection of skin AND/OR subcutaneous tissue: life-threatening infections, up to 7.5 mg/kg/day IV or IM in three equal doses administered every 8 hours; reduce dose to 6 mg/kg/day or less as soon as clinically indicated.
  • Infectious disease of abdomen: non-life-threatening infections, 4 to 6 mg/kg/day IV or IM in three equal doses every 8 hours, two equal doses every 12 hours, or once daily for 7 to 14 days.
  • Infectious disease of abdomen: life-threatening infections, up to 7.5 mg/kg/day IV or IM in three equal doses administered every 8 hours; reduce dose to 6 mg/kg/day or less as soon as clinically indicated.
  • Lower respiratory tract infection: non-life-threatening infections, 4 to 6 mg/kg/day IV or IM in three equal doses every 8 hours, two equal doses every 12 hours, or once daily for 7 to 14 days.
  • Lower respiratory tract infection: life-threatening infections, up to 7.5 mg/kg/day IV or IM in three equal doses administered every 8 hours; reduce dose to 6 mg/kg/day or less as soon as clinically indicated.
  • Urinary tract infectious disease: 4 to 6 mg/kg/day IV or IM in three equal doses every 8 hours, two equal doses every 12 hours, or once daily for 7 to 14 days.
  • Urinary tract infectious disease: uncomplicated, 3 mg/kg/day IM for 7 to 10 days.
Pediatric
  • Disease due to Gram-negative bacteria, Susceptible infections due to Pseudomonas and other gram-negative organisms: (neonates, premature and normal gestational age) 0 to 1 week of age, 3 mg/kg IV or IM every 12 hours.
  • Disease due to Gram-negative bacteria, Susceptible infections due to Pseudomonas and other gram-negative organisms: (neonates and infants) over 1 week of age, 2.5 to 3 mg/kg IV or IM every 8 hours.
  • Disease due to Gram-negative bacteria, Susceptible infections due to Pseudomonas and other gram-negative organisms: children, 2 to 2.5 mg/kg IV or IM every 8 hours.
  • Infection of skin AND/OR subcutaneous tissue: (neonates, premature and normal gestational age) 0 to 1 week of age, 3 mg/kg IV or IM every 12 hours.
  • Infection of skin AND/OR subcutaneous tissue: (neonates and infants) over 1 week of age, 2.5 to 3 mg/kg IV or IM every 8 hours.
  • Infection of skin AND/OR subcutaneous tissue: children, 2 to 2.5 mg/kg IV or IM every 8 hours.
  • Infectious disease of abdomen: (neonates, premature and normal gestational age) 0 to 1 week of age, 3 mg/kg IV or IM every 12 hours.
  • Infectious disease of abdomen: (neonates and infants) over 1 week of age, 2.5 to 3 mg/kg IV or IM every 8 hours.
  • Infectious disease of abdomen: children, 2 to 2.5 mg/kg IV or IM every 8 hours.
  • Lower respiratory tract infection: (neonates, premature and normal gestational age) 0 to 1 week of age, 3 mg/kg IV or IM every 12 hours.
  • Lower respiratory tract infection: (neonates and infants) over 1 week of age, 2.5 to 3 mg/kg IV or IM every 8 hours.
  • Lower respiratory tract infection: children, 2 to 2.5 mg/kg IV or IM every 8 hours.
  • Urinary tract infectious disease: (neonates, premature and normal gestational age) 0 to 1 week of age, 3 mg/kg IV or IM every 12 hours.
  • Urinary tract infectious disease: (neonates and infants) over 1 week of age, 2.5 to 3 mg/kg IV or IM every 8 hours.
  • Urinary tract infectious disease: children, 2 to 2.5 mg/kg IV or IM every 8 hours.

Dose Adjustments

  • Renal impairment: dose adjustment is necessary: give initial dose, draw at least 2 serum drug levels and make dose and interval adjustments based on patient-specific pharmacokinetic parameters
  • Hemodialysis: 2 mg/kg following each dialysis session; make adjustments based on serum drug concentrations
  • Obese patients: dosing should be based on ideal body weight; in morbidly obese patients, dosing weight = ideal body weight + 0.4 (total body weight - ideal body weight)

FDA-Labeled Indications

  • Disease due to Gram-negative bacteria, Susceptible infections due to Pseudomonas and other gram-negative organisms.
  • Gonorrhea
  • Infection of skin AND/OR subcutaneous tissue.
  • Infectious disease of abdomen.
  • Lower respiratory tract infection.
  • Urinary tract infectious disease.

Non-FDA Labeled Indications

  • Febrile neutropenia
  • Postoperative septicemia; prophylaxis

Adapted from:

1. Product Information: NETROMYCIN(TM) injection, netilmicin sulfate injection. Fulford (India) Limited, Bombay, India, 2006.

2. Product Information: Netromycin(R), netilmicin sulfate injection, USP. Schering Corp., Kenilworth, NJ, 1987.

3. Batagol RBatagol R (Ed): Australian Drug Evaluation Committee: Medicines in Pregnancy-An Australian categorisation of risk of drug use in pregnancy, 3rd. Australian Government Publishing Service, Canberra, Australia, 1996.

Mechanism of Action

Netilmicin interferes with bacterial protein synthesis by binding to ribosomal RNA.

References

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