netilmicin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

IM, IV: 4–7.5 mg/kg daily, as a single daily dose or in divided doses every 8 or 12 hoursUrinary tract infection: 150 mg daily for 5 days

PHARMACOKINETICS

Molecular weight :1441.6 (as sulphate)

%Protein binding :<5

%Excreted unchanged in urine : 80

Volume of distribution (L/kg) :0.16–0.3

half-life – normal/ESRD (hrs) :2–2.5/35–72

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : 4–7.5 mg/kg once daily. Monitor levels

10 to 20 : 3–4 mg/kg once daily. Monitor levels

<10 : 2 mg/kg once daily. Monitor levels

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. IV: 2 mg/kg on alternate daysIP: 7.5–10 mg/L per exchange. Monitor levels

HD :Dialysed. Administer 2 mg/kg at the end of each dialysis session. Monitor levels

HDF/high flux :Dialysed. Administer 2 mg/kg at the end of each dialysis session. Monitor levels

CAV/VVHD :Dialysed. Dose as in GFR=10–20 mL/min. Monitor levels

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsBotulinum toxin: neuromuscular block enhanced (risk of toxicity)

Ciclosporin: increased risk of nephrotoxicityCytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds

Diuretics: increased risk of ototoxicity with loop diureticsMuscle relaxants: effects of non- depolarising muscle relaxants and suxamethonium enhancedParasympathomimetics: antagonism of effect of neostigmine and pyridostigmine

Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

IM, IP, IV bolus or infusion

Rate of Administration

IV bolus: Administer over 3–5 minutes

IV infusion

: Administer over 0.5–2 hours

Comments

Add to 50–200 mL of sterile water for injection, sodium chloride 0.9%, glucose 5% or 10%IM and IV dose are identical. Calculate on mg/kg lean body weight, or actual weight, whichever is lower

OTHER INFORMATION

Netilmicin serum concentrations should be monitored and used for basis of dosage adjustment, otherwise follow guidelines in the SPC according to serum creatinine/creatinine clearanceOnce-daily administration of netilmicin may lead to transient peak concentrations of 20–30 micrograms/mL. Other dosage regimens will result in peak levels not exceeding 12 micrograms/mL. Prolonged levels above 16 micrograms/mL should be avoided. If trough levels are monitored they will usually be 3 micrograms/mL or less with the recommended dosage. Increasing trough concentrations above 4 micrograms/mL should be avoided.

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