Category:

• Antibiotic

Description:

• Aminoglycoside antibiotic

Indications:

• Mycobacterium tuberculosis

• Nontuberculosis infections:

  • Pasteurella pestis (plague)

  • Francistularensis (tularemia)

  • Brucella

  • Calymmatobacterium granulomatis

  • Haemophilus ducreyi (chancroid)

  • H. influenzae, K. pneumoniae, E. coli, Proteus species, A. aerogenes, K. pneumoniae, Enterococcus faecalis, S. viridans)

• Unlabeled uses:

  • Mycobacterium avium complex

Contraindications:

• 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

• Monitor peak and trough serum concentrations

• In patients with extensive burns, altered pharmacokinetics may alter serum concentrations.

• May produce hypomagnesemia, especially if poor or restricted diet.

• 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.

Adverse Reactions (Side Effects):

• Central and peripheral nervous system reactions: lethargy, neuromuscular blockade, facial neurotoxicity, peripheral parasthesia, muscular weakness

• Gastrointestinal: vomiting, nausea

• Hematologic: altered WBC counts

• Hypersensitivity: rash, urticaria, itching

• Special senses: vertigo, hearing loss

• Renal: azotemia

• Pain at injection site

Dosage:

• Administered by IM injection

• Adults:

  • normal renal function: 1-2 grams in divided doses q6-12h (not to exceed 2 grams per day)

• Children:

  • 20-40mg/kg/day in divided doses q6-12h

• Tuberculosis (administered by single IM injection):

  • Adults: 15mg/kg/day or 25-30mg/kg twice a week  or 25-30mg three times weekly

  • Children: 20-40mg/kg/day or 25-30mg/kg twice a week  or 25-30mg three times weekly

• Tularemia: 

  • 1-2 grams per day in divided doses for 7-14 days (or until 5 days afebrile)

• Plague: 

  • 2 grams daily in two divided doses for minimum of 10 days

• Bacterial endocarditis (streptococcal): 

  • 1 gram bid for first week, 500mg bid for second week (given with a penicillin)

• Bacterial endocarditis (enterococcal): 

  • 1 gram tid for 2 weeks, then 500mg bid for 4 weeks (given with a penicillin)