netilmicin and Infant--Newborn--Diseases

Longitudinal assessment of intensive care nursery infants given aminoglycoside antibiotics revealed no significant difference in the incidence of hearing impairment when compared with age- and sex-matched controls. Bilateral sensorineural impairment was confirmed in three (2%) infants, one each given netilmicin and amikacin and one untreated control infant. There was a high incidence of transient auditory abnormalities in this intensive care infant population. These findings emphasize the importance of long-term follow-up hearing evaluations in infants who require intensive care management in the neonatal period.

Topics: Amikacin; Audiometry, Evoked Response; Bilirubin; Clinical Trials as Topic; Creatinine; Female; Follow-Up Studies; Gentamicins; Hearing Loss, Sensorineural; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kanamycin; Longitudinal Studies; Male; Netilmicin; Prospective Studies

Topics: Amikacin; Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Infant, Newborn; Infant, Newborn, Diseases; Microbial Sensitivity Tests; Netilmicin; Staphylococcal Infections

Topics: Animals; Anthrax; Bacillus anthracis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Netilmicin; Penicillin G; Sepsis; Sutures; Umbilicus; Wool

We tried to adapt the dose of netilmicin in an intensive care unit on 41 newborns, under 8 days of age. Individual pharmacokinetic parameters were calculated after the first intramuscular dose administration and the initial dose (3 mg/kg/twice a day) was modified in 17 cases. Methodologic problems but mainly great variations in physiology and pathology explain the difficulties in predicting the serum concentration (peak and valley) on the 7th day. A decrease in the daily dose for the preterm infant, compared to the one used in full-term infant, and a drug concentration monitoring are advised.

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Postmature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Kinetics; Netilmicin

Topics: Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Kidney; Lung; Netilmicin; Tissue Distribution

The pharmacokinetics of netilmicin were analyzed in 30 children, including 13 premature and seven gestationally mature newborns. Ten were children ranging in age from 3.5 months to 13 years. The newborns exhibited more variation in serum levels than the older children, and the premature babies more than those born at term. The serum half-life (t1/2), tended to show higher values in premature than in mature newborns, although this was not statistically significant. The newborns had a t1/2 of 5.9 hours, compared to 2.5 hours in the older children. There was no statistically significant difference in distribution volumes or coefficients between the two groups of newborns who had an insignificantly higher relative apparent beta-phase distribution volume coefficient of 0.420 l/kg, compared to 0.377 l/kg in the older children. All had distribution coefficient values within the same range. The total body clearance in absolute terms, and when referred to body surface of 1.73 m2, was significantly lower in the newborns than in the older children, but the clearance, when referred to body weight, was of the same order in the babies and older children. The age differences affect dosage. Dosage schedules based on pharmacokinetics are proposed for gestationally premature babies, mature newborns, and older children. Premature infants can receive 2.5 mg/kg body weight and gestationally mature newborns 3.0 mgkg, both every 12 hours; the monitoring of serum concentrations is mandatory. Children aged three months and older can receive 3.0 mg/kg every eight hours.

Topics: Adolescent; Age Factors; Bacterial Infections; Body Surface Area; Body Weight; Child; Child, Preschool; Gentamicins; Gestational Age; Half-Life; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Kinetics; Netilmicin

Twenty-five hospitalized neonates, each with two or more serious symptomatic infections, were given netilmicin by intramuscular injection. The antibiotic was administered usually at 1.5 or 3.0 mg/kg twice a day (q 12 hr) for 7 to 13 days. At the end of therapy the signs and symptoms of infection were completely resolved in twenty-four of the twenty-five patients and markedly improved in the remaining one. Thirty-five causative organisms were isolated from 30 of the 59 infection sites; after netilmicin therapy 31 causative organisms were completely eliminated and 4 were markedly reduced in number. One of the babies had a slight increase in serum creatinine level, possibly related to therapy, and a mild transient rash which was doubtfully related to netilmicin. None of the other neonates had adverse reactions.

Topics: Bacterial Infections; Female; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Netilmicin

Thirty neonates and infants have been treated for verified or suspected infections with a combination of netilmicin and ampicillin intravenously for 7 days. The infecting organisms were isolated in 18 patients, of whom 2 had osteomyelitis and 2 had pneumonia. In 3 cases of pneumonia and 9 cases of suspected septicaemia bacteriological cultures were negative. None of the children died, and in all but the 2 cases of osteomyelitis, therapy led to complete resolution of the signs of infection and recovery without sequelae. No adverse reactions to antibiotic therapy were recorded. Upon follow-up examinations at the age of 3 months there has been no sign of auditory impairment as assessed by Brain Stem Evoked Response. Netilmicin is thus tolerated well in neonates and infants, and when guided by serum concentrations considered to be a safe and reliable aminoglycoside.

Topics: Drug Evaluation; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Netilmicin; Osteomyelitis; Sepsis; Staphylococcal Infections; Streptococcal Infections

38 newborn infants, 28 males and 10 females, were treated with netilmicin in doses 6-7 mg/kg/day for suspected or verified infections. 19 patients were mature (mean birth weight 3169 g) and 19 were premature (mean birth weight 1864 g). 32 had moderate or severe underlying diseases. 37 babies survived, 33 were cured or improved markedly and in 4 the results were indeterminate. Pathogenic bacteria were demonstrated in 24 cases and were eliminated in 15. Only one baby died. He suffered from severe respiratory distress syndrome and Escherichia coli septicemia. No E. coli was isolated at autopsy. The mean netilmicin peak serum value was 7.7 micrograms/ml (range 1.0-30.0) and the mean trough concentration 2.1 micrograms/ml (range 0.0-9.2). No adverse effects were seen.

Topics: Bacterial Infections; Drug Evaluation; Enterobacteriaceae Infections; Female; Gentamicins; Haemophilus Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Netilmicin; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

An outbreak of amikacin-resistant Enterobacteriaceae (KES) occurred in the Intensive Care Nursery (ICN) of the Louisville General Hospital from January 1978 through March 1978. Epidemic disease and an increased colonization rate in newborn infants due to amikacin-resistant microorganisms has not been documented previously. Three of the 11 neonates died. The organisms isolated were resistant to amikacin and two experimental aminoglycosides, sissomicin and netilmicin. The outbreak was contained following institution of several control measures, including pharyngeal inoculation of an experimental strain of alpha streptococcus in four infants.

Topics: Amikacin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units; Kanamycin; Klebsiella Infections; Klebsiella pneumoniae; Male; Netilmicin; Nurseries, Hospital; Serratia marcescens; Sisomicin

49 newborns and infants were treated with netilmicin for verified or suspected infections. Infection was verified in 23 patients (mean gestational age 32 weeks and mean body weight 2100 g) and clinical cure or marked improvement occurred in 20 of these. Of the remaining 3 patients, 2 died, partly due to reasons unassociated with infection. 25 causative organisms were isolated and bacteriological elimination was achieved in 73% of the cases. At an average dose of 2.6 mg/kg twice a day, peak serum concentrations (30 min following injection) were 7.4 +/- 3.4 micrograms/ml. Serum half life was approximately 4.5 hours for infants born at term, and longer at shorter gestational age. Netilmicin is considered a safe and efficient aminoglycoside with a low rate of adverse effects.

Topics: Bacterial Infections; Drug Evaluation; Escherichia coli Infections; Female; Gentamicins; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Klebsiella Infections; Male; Netilmicin; Sepsis; Staphylococcal Infections; Streptococcal Infections

40 newborn infants and children were treated with netilmicin. With a 2-mg/kg dose, the average peak serum concentration was 4.4 microgram/ml. Serum concentrations resulting from the first dose were markedly lower than subsequent doses and therapeutically inadequate. Significant drug accumulation did not occur: peak and trough concentrations on days 2 and 7 were the same in patients with normal renal function. The half-life of netilmicin in infants less than 1 week old was 3.8 h in infants older than 1 week. Infants less than 7 days old require a prolonged dose interval (12 h) to adequately clear the administered dose. Recovery of netilmicin in urine ranged from 50 to 100% and correlated with age and duration of treatment. Elimination of netilmicin was prolonged in newborn infants with renal failure and requires dosage adjustment. Transient change in creatinine clearance occurred in 2 patients (4.6%) and ototoxicity was observed on 2 other patients.

Topics: Adolescent; Bacteria; Bacterial Infections; Child; Gentamicins; Half-Life; Hearing; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Netilmicin

Netilmicin and gentamicin susceptibilities of 258 gram-negative organisms and 25 strains of Staphylococcus aureus were nearly identical. The pharmacokinetic properties of netilmicin were evaluated in 101 newborn infants and related to birth weight, gestational age, chronological age, and route of administration. Mean peak serum concentrations of 5.6 to 6.9 and 7.8 to 8.4 mug/ml were observed 30 min after 3- and 4-mg/kg doses, respectively, were given intramuscularly. The peak concentrations were directly related to gestational age. The average serum half-life values varied from 3.4 to 4.7 h and in general were inversely related to birth weight, gestational age, and postnatal age. The pharmacokinetics of netilmicin in 10 infants were similar after intramuscular and intravenous administration. A comparative study of netilmicin and gentamicin in seven neonates revealed greater variability in serum concentrations of gentamicin and a shorter half-life for netilmicin. There was evidence of accumulation of netilmicin in 12 low-birth weight, premature infants who received 4-mg/kg doses for an average of 6.4 days. Serum and urine levels of netilmicin were measured up to 11 days after discontinuation of the drug. These data are well characterized by a two-compartment model. Additional studies of efficacy and long-term toxicity of netilmicin in neonates are necessary.

Topics: Bacteria; Gentamicins; Half-Life; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Injections, Intravenous; Kinetics; Models, Biological; Netilmicin