Amikacin

When ATH:
J01GB06

Characteristic.

Antibiotics group aminoglikozidov III generation, TB drug II series. Received by polusinteticski of LMT and.

Amikaczina sulfate — amorphous powder of white or white with a yellowish tint. Hygroscopic, easily soluble in water. Molecular weight 781,75.

Pharmacological action.
Broad-spectrum antibacterial, TB, bactericide.

Application.

Infectious-inflammatory diseases, caused by Gram-negative microorganisms (resistant to gentamicin, sizomicinu and kanamycin) or associations of grampolaugitionah and gramotricationah microorganisms: respiratory tract infections (bronchitis, pneumonia, empyema, lung abscess), sepsis (incl. caused by strains Enterobacteriaceae and Pseudomonas aeruginosa, resistant to other aminoglycosides), bacterial endocarditis, CNS infections (including meningitis), infection of the abdominal cavity (incl. peritonitis), urinary tract infection (pyelonephritis, cystitis, uretrit), prostatitis, gonorrhea, purulent infections of the skin and soft tissues (incl. infected burns, infected sores and decubitus different Genesis), biliary tract infections, bone and joint infections (incl. osteomyelitis), wound infection, postoperative infections, otitis. Tuberculosis (reserve drug) - in combination with other reserve drugs.

Contraindications.

Hypersensitivity, incl. other aminoglycosides; damage to the auditory and vestibular apparatus of non-tuberculous etiology, incl. neuritis of the auditory nerve, impairment of renal function (renal failure, uremia, azotemia), severe diseases of the heart and hematopoietic organs.

Restrictions apply.

Myasthenia, parkinsonizm, degidratatsiya, advanced age, the neonatal period, incl. in preterm infants.

Pregnancy and breast-feeding.

Use during pregnancy is possible only for health reasons. Passes through the placenta, found in fetal blood serum at concentrations, of about 16% from that in the mother's blood serum, and amniotic fluid. May accumulate in fetal kidneys, provide nephro- and ototoxic effects.

Category actions result in FDA - D. (There is evidence of the risk of adverse effects of drugs on the human fetus, obtained in research or practice, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk, if the drug is needed in life-threatening situations or severe disease, when safer agents should not be used or are ineffective.)

Excreted in breast milk in small quantities. At the time of treatment should stop breastfeeding.

Side effects.

From the nervous system and sensory organs: headache, paraesthesia, clonus, convulsions, tremor, drowsiness, neuromuscular transmission disorder (muscular weakness, difficulty breathing, apnea), psychosis, hearing loss (stuffy feeling or tinnitus, hearing loss with decreased perception of high tones, irreversible deafness) and balance (uncoordinated movements, dizziness, instability).

Cardio-vascular system and blood (hematopoiesis, hemostasis): heartbeat, hypotension, anemia, leukopenia, thrombocytopenia, granulocytopenia, eozinofilija.

From the digestive tract: nausea, vomiting, diarrhea, dysbiosis, increase in liver transaminases, giperʙiliruʙinemija.

With the genitourinary system: kidney disease (albuminuria, hematuria, oligurija, renal failure).

Allergic reactions: itching, hives, arthralgia, angioedema, anaphylactic shock.

Other: drug fever, soreness at the injection site, dermatitis, phlebitis and periphlebitis (at / in the introduction).

Cooperation.

There is physical and chemical incompatibility with penicillins, especially carbenicillin. Pharmaceutical incompatible with heparin, cephalosporins, Tetracycline, amphotericin B, chlorothiazide, Erythromycin, nitrofurantoinom, sulfadiazine, vitamins C and group B, potassium chloride. Shows synergism with beta-lactam antibiotics against many gram-negative microorganisms, with ticarcillin, azlocillin and piperacillin against Pseudomonas aeruginosa and other non-fermentative gram-negative bacteria. With the simultaneous and / or sequential use of two or more aminoglycosides (neomycin, Streptomycin, kanamycin, gentamicin, monomicin, tobramycin, netilmycin) their antibacterial activity is weakened (competition for a mechanism of "capture" of microbial cells), and toxic effects are amplified. Amiloride reduces amikacin nephrotoxicity (by reducing penetration into the proximal tubules). When taken simultaneously with amphotericin B, cephalothin, polymyxin, cisplatin, vancomycin and nalidixic acid increases the risk of nephrotoxicity. Loop diuretics (furosemid, ethacrynic acid) and cephalothin increase ototoxicity. Indomethacin, when administered intravenously, reduces the renal clearance of amikacin and increases its plasma concentration and the risk of toxicity.. In an application with means for inhalation anesthesia, kurarepodobnymi drugs, opioid analgesics, magnesium sulfate and polymyxin for parenteral administration, as well as large quantities of blood transfusions with citrate preservative enhanced neuromuscular blockade. Reduces the effectiveness of drugs antimiastenicheskih (their dosage needs to be adjusted).

Overdose.

Symptoms: toxic reactions, neuromuscular blockade until the cessation of breathing, infants - CNS depression (slackness, stupor, coma, profound respiratory depression).

Treatment: calcium chloride / in, anticholinesterase agents (neostigmine n / a), m-cholinoblockers (atropyn), simptomaticheskaya therapy, if necessary - IVL. Hemodialysis, Peritoneal dialysis is effective for renal dysfunction, newborns receive exchange transfusions.

Dosing and Administration.

/ M, I / (spray, during 2 m, or drip, with speed 60 drops per minute). Adults and children: by 5 mg / kg every 8 or h 7,5 mg / kg every 12 no; the maximum dose - 15 mg / kg / day, course dose no more 15 g. Premature newborns: at the initial dose 10 mg / kg, then 7,5 mg/kg every 18–24 hours; for newborns the initial dose is 10 mg / kg, then 7,5 mg / kg every 12 no. Duration of treatment with intravenous administration: 3–7 days, with IM - 7–10 days. Patients with renal failure require dosage adjustment according to creatinine clearance.

Precautions.

Do not mix with other drugs in the same syringe or infusion system. (formation of inactive complex compounds is possible). Renal function should be monitored before and weekly during treatment. (incl. serum creatinine and urea nitrogen levels) and VIII pairs of cranial nerves (audiogram). Continuous pharmacokinetic monitoring (C_max determined through 30 Mines and 1 h after IV and IM injections, respectively, C_min - across 6 no) eliminates the creation of toxic or subtherapeutic concentrations in the blood. Be wary of the drivers of vehicles and people, whose activities require increased concentration and good coordination of movements.

Cautions.

Before use, the sensitivity of microorganisms should be determined..

Solution for injection and infusion is prepared immediately before use.. Contents of the bottle (0,25–0.5 g) dissolve in 2–3 ml of sterile water for injection; for IV infusions, the resulting solution is diluted in 200 ml 0,9% sodium chloride solution or 5% dextrose.

Cooperation