Netilmicin
When ATH:
J01GB07
Characteristic.
Semi-synthetic aminoglycoside antibiotic III generation, derivative sizomitsina. Soluble in water.
Pharmacological action.
Antibacterial broad-spectrum, bactericide.
Application.
Bacterial infections are severe, caused by susceptible microorganisms: sepsis, septicemia (including neonatal sepsis), CNS infections (incl. meningitis), endokardit, infections of the urinary tract and genital organs (incl. gonorrhea), biliary tract infections, severe infections of the respiratory system (incl. pneumonia, empyema, lung abscess), purulent infections of the skin and soft tissues (incl. infected burns and wounds), abdominal infections (incl. peritonitis), GI infections, bone and joint infections (incl. osteomyelitis), postoperative infections.
Contraindications.
Hypersensitivity, incl. other aminoglycosides history; neuritis of the auditory nerve, severe chronic renal failure with azotemia and uremia.
Restrictions apply.
Myasthenia, parkinsonizm, botulism (aminoglycosides can cause a violation of neuromuscular transmission, which leads to a further weakening of the skeletal muscles), degidratatsiya, renal failure, the neonatal period, premature babies, advanced age.
Pregnancy and breast-feeding.
In case of need for life-threatening condition or to treat severe diseases, when other drugs can not be used or are ineffective, It should be carefully weighed against the risks and benefits. Netilmicin found in umbilical cord blood and the human fetus.
Studies have shown, that nursing mothers netilmicin small amount excreted in breast milk. In view of the possibility of serious side effects, or to stop the use of netilmicin, or to stop breastfeeding.
Side effects.
From the nervous system and sensory organs: headache, malaise, disorientation, paraesthesia, violation of neuromuscular transmission (incl. respiratory failure), blurred vision, ototoxicity (hearing loss, or ringing sensation in the ears laying, irreversible deafness, violation of vestibular and cochlear function; toxic effects on the vestibular apparatus is shown loss of coordination, dizziness, toshnotoy, vomiting).
Cardio-vascular system and blood (hematopoiesis, hemostasis): tachycardia, hypotension, heartbeat, thrombocytosis / thrombocytopenia, leukopenia, anemia, increase in PV.
From the digestive tract: decreased appetite, vomiting, diarrhea, abnormal liver function, giperglikemiâ.
With the genitourinary system: Nephrotoxicity is a violation of the kidney (increase or decrease in urinary frequency, thirst, oligurija, proteinuria, hematuria, цilindrurija, reduction in glomerular filtration rate, increasing concentrations of urea).
Allergic reactions: rash, itch, dermahemia, chills, fever, angioedema.
Other: fluid retention, giperglikemiâ, hyperkalemia, It reported on the development of Fanconi syndrome (urinary excretion of amino acids and the development of metabolic acidosis); soreness at the injection site.
Cooperation.
Nephrotoxicity- ototoxicity and reinforce other drugs, It has the same side effects. There are reports of an increase in the combined use of nephrotoxicity of aminoglycosides and some cephalosporins. In combination with anesthetics and muscle relaxants, and after massive blood transfusion, sodyerjashyei tsitratnyi anticoagulant, may increase neuromuscular blockade and respiratory paralysis. Should be avoided in conjunction with cisplatin, netilmicin, Polymyxin B, Acyclovir, other aminoglycosides, ethacrynic acid, furosemidom. The on / in the introduction diuretics may enhance the toxicity of the aminoglycoside by changing the antibiotic concentration in serum and tissues.
It has been shown cross-allergenicity aminoglycosides.
In vitro marked synergism with benzylpenicillin against most strains Streptococcus faecalis, with carbenicillin (or ticarcillin) against many strains Pseudomonas aeruginosa, with carbenicillin, Azlocillin, mezlocillin, цefamandolom, cefotaksimom or moksalaktamom — against strains Serratia spp. Parenteral administration of indomethacin increases the risk of toxic effects of aminoglycosides due to the increase of T1/2 and clearance.
Overdose.
Symptoms: toxic reactions (hearing loss, ataxia, dizziness, urination disorders, thirst, decreased appetite, nausea, vomiting, or ringing sensation in the ears laying, respiratory failure).
Treatment: for the lifting of the embargo neuromuscular transmission and its consequences — hemodialysis or peritoneal dialysis, anticholinesterase drugs, calcium supplements, IVL, other symptomatic and supportive therapy.
Dosing and Administration.
/ M or I / -4-6 mg/kg/day equal portions, 8-12 hours (2-3 Times). In heavy infections dose can be increased to 7,5 mg/kg/day in three equal introduction; through 48 h the dose to 6 mg/kg/day or less. With infections of the urinary tract (without bacteremia) -4-6 mg/kg/day in three equal portions with an interval 8 no, or two portions with an interval 12 no, 7-10 days. Children are usually in a daily dose of 6-7, 5 mg/kg (for 2.0-2.5 mg/kg every 8 no); newborn older 1 Ned and infants-a daily dose of 7.5-9.0 mg/kg (2,5-3 mg/kg every 8 no), premature and newborn up 1 Sun - 6 mg / kg / day (by 3,0 mg / kg every 12 no). The course duration is 7-14 days. In gonoree in both men and women — once, 300 mg, / m, deep on 1/2 the dose in each buttock.
In case of violation of renal excretory function reduce the dose or increase the interval between doses.
Precautions.
In the treatment requires regular (at least 1 times a week) monitoring of renal function, VIII cranial nerves. When poor audiometric test dose reduce or stop treatment.
The risk of nephrotoxicity was higher in patients with impaired renal function, with people, receiving the drug at high doses, or for a long time, as well as in elderly patients. Signs of ototoksičnosti — decrease of hearing and vestibular dysfunction is more often occur in people with impaired kidney or in patients with normal renal function, receiving the drug at higher doses or for more prolonged time, than recommended. There should be no joint and / or sequential systemic or topical use of other potentially neuro- and nephrotoxic drugs.
It is necessary to control the content of the drug in the blood serum, which will ensure the presence of a sufficient amount of the antibiotic in the blood and increase the concentration to avoid potentially toxic levels. When checking minimum concentrations of netilmicin dose adjusted so, to avoid long-term excess 16 ug / ml. To calculate the required dosage should determine the patient's body weight before treatment.
Be wary appoint patients with neuromuscular disorders (myasthenia gravis, parkinsonizm, infant botulism).
