netilmicin and Ear-Diseases

The effectiveness and safety of once-daily versus several-times-daily aminoglycosides were studied in a meta-analysis. MEDLINE for 1988 to 1995 was searched, and additional studies were identified from review articles and references in retrieved articles. Studies selected for meta-analysis were randomized controlled clinical trials in nonneutropenic adult patients comparing the clinical effectiveness or nephrotoxicity or ototoxicity of once-daily with several-times-daily aminoglycosides. Differences between groups were expressed as odds ratios. The results were combined by the procedure of Mantel and Haenszel, and 95% confidence intervals and exact confidence intervals were computed. An odds ratio smaller than 1 would indicate a lesser likelihood of a given endpoint in the once-daily group, and an odds ratio greater than 1 would indicate a greater likelihood. Eighteen studies involving 2317 patients were included in the meta-analysis. Summary odds ratios were 1.47 for effectiveness (95% CI = 1.13-1.94), 0.56 for ototoxicity (95% CI = 0.26-1.16), and 0.60 for nephrotoxicity (95% CI = 0.40-0.86). A meta-analysis showed that treatment with single daily doses of aminoglycosides seems to be more effective, less nephrotoxic, and as ototoxic as multiple doses daily.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Controlled Clinical Trials as Topic; Drug Administration Schedule; Ear Diseases; Gentamicins; Humans; Infections; Kidney Diseases; Middle Aged; Netilmicin

This article reviews the clinical pharmacokinetics, clinical toxicity and cost-effectiveness analysis of aminoglycosides and of dosing services for aminoglycosides. The reader is referred elsewhere for a review of the pharmacology, antimicrobial spectrum of activity and clinical use of these drugs. A critique of the more commonly used methods of aminoglycoside dosage determinations is included, based on the inter-individual variation in aminoglycoside disposition parameters. The advantages and disadvantages of arbitrary, predictive, and pharmacokinetic methods of dosing determination are summarized. Justification for the routine determination of serum aminoglycoside concentrations is reviewed. We review the lack of standardization of definitions for aminoglycoside-associated nephrotoxicity in published studies, and studies which illustrate these differences are highlighted. Evidence for the association between serum aminoglycoside concentrations and nephrotoxicity is examined. Ototoxicity is similarly reviewed. The concept of cost-effectiveness analysis is examined extensively in this review. We discuss the literature concerning the cost benefit analysis of drug dosing services.

Topics: Amikacin; Aminoglycosides; Cost-Benefit Analysis; Ear Diseases; Gentamicins; Humans; Kidney Diseases; Netilmicin; Tobramycin

A survey is made of comparative studies of ototoxicity of different aminoglycoside antibiotics. Animal studies show clearly lower netilmicin ototoxicity compared with that of other aminoglycoside antibiotics. Clinical controlled comparative trials are few. Most studies have few patients in each group. The significance of auditory threshold shifts in single frequencies as criteria of ototoxicity is uncertain. An analysis of clinical and animal studies together indicates, however, that netilmicin has a higher ratio of efficacy to ototoxicity than other aminoglycoside antibiotics.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Clinical Trials as Topic; Drug Evaluation, Preclinical; Ear Diseases; Guinea Pigs; Humans; Netilmicin

For a decade gentamicin has been used extensively because of its antimicrobial efficacy and the relatively low prevalence of clinical toxicity. Recently the more frequent appearance of resistant organisms, reports of increased nephrotoxicity and ototoxicity, and the development of newer aminoglycoside antibiotics have raised doubts about the continued use of this agent. This paper reassesses the role of gentamicin. It is clear that an appreciation of the pharmacokinetics and the clinical use of gentamicin as well as an understanding of the patterns of toxicity in animals and humans can lead to more efficient treatment with this antimicrobial agent. Despite ample competition from a number of newer aminoglycoside antibiotics, gentamicin will probably continue to be used widely in the near future.

Topics: Amikacin; Animals; Bacterial Infections; Drug Synergism; Ear Diseases; Gentamicins; Humans; Kidney; Kidney Diseases; Netilmicin; Penicillin Resistance; Penicillins; Respiratory Tract Infections; Sisomicin; Tobramycin; Urinary Tract Infections

In two prospective, randomized studies conducted in West Germany and involving 80 patients, netilmicin-ticarcillin was compared to tobramycin-ticarcillin in the treatment of serious systemic infections. Both regimens were essentially identical with respect to the clinical and bacteriological results they produced. The netilmicin group developed significantly less nephrotoxicity than the tobramycin group (0% versus 15%, P = 0.03). Ototoxicity also occurred less frequently in the netilmicin-treated patients (3% versus 10%, P = 0.4). In a large collaborative study involving 15 centres, 254 patients were enrolled. Clinical and bacteriological responses were excellent, with netilmicin and tobramycin equally effective, but the incidences of nephrotoxicity and ototoxicity were lower in patients treated with netilmicin than those receiving tobramycin.

Topics: Acute Kidney Injury; Aged; Bacterial Infections; Clinical Trials as Topic; Ear Diseases; Female; Gentamicins; Gram-Negative Bacteria; Humans; Male; Netilmicin; Random Allocation; Tobramycin

A survey is made of comparative studies of ototoxicity of different aminoglycoside antibiotics. Animal studies show clearly lower netilmicin ototoxicity compared with that of other aminoglycoside antibiotics. Clinical controlled comparative trials are few. Most studies have few patients in each group. The significance of auditory threshold shifts in single frequencies as criteria of ototoxicity is uncertain. An analysis of clinical and animal studies together indicates, however, that netilmicin has a higher ratio of efficacy to ototoxicity than other aminoglycoside antibiotics.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Clinical Trials as Topic; Drug Evaluation, Preclinical; Ear Diseases; Guinea Pigs; Humans; Netilmicin

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Therapy, Combination; Ear Diseases; Female; Gentamicins; Humans; Kidney Diseases; Netilmicin

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Drug Resistance, Microbial; Ear Diseases; Humans; Kidney Diseases; Netilmicin

Topics: Amikacin; Aminoglycosides; Animals; Anti-Bacterial Agents; Body Weight; Cochlea; Ear Diseases; Electrophysiology; Female; Gentamicins; Guinea Pigs; Hearing Disorders; Male; Netilmicin; Tobramycin