Category:

• Antibiotic

Description:

• Aminoglycoside antibiotic

Indications:

• Suppression of bowel intestinal bacteria

• Hepatic coma

Contraindications:

• Presence of intestinal obstruction

• Generally not indicated for long-term therapy due to nephrotoxocity and ototoxicity

Precautions:

• Pregnancy category D

• May cause nephrotoxicity, therefore closely monitor renal function, especially in elderly patients.

• May cause ototoxicity, therefore monitor hearing

• Aminoglycosides have neuromuscular blockade activity with a curare-like effect.  Monitor patient’s neuromuscular function, especially in patients with myasthenia gravis, parkinsonism or infant botulism.

• Used in combination for bowel surgery preparation (used with minimal diet, bisacodyl, magnesium sulfate, enema, and supplemental IV fluids)

Adverse Reactions (Side Effects):

• Gastrointestinal: vomiting, nausea, anorexia

• “Malabsorption syndrome” characterized by increase in fetal fat, decrease in serum carotene and fall in xylose absorption

• Increases fecal bile acid excretion and reduces intestinal lactase activity

Dosage:

• Administered orally

• Hepatic coma:

  • Adults: 4-12 grams per day in divided doses

  • Children: 50-100mg/kg/day in divided doses for a period of 5-10 days

• Bowel preparation:

  • 1 gram (in combination with 1 gram erythromycin) for three doses at time periods of time of actual surgery minus 19 hours (T-19), minus 18 hours (T-18) and minus 9 hours (T-9)