netilmicin and Lung-Diseases

High-dose anti-Pseudomonas chemotherapy is mandatory in the treatment of acute pulmonary exacerbations in patients with advanced cystic fibrosis and Pseudomonas aeruginosa isolated from their sputum. However, neither the regimen itself nor its objective evaluation have been optimized yet. In a prospective controlled evaluation 42 such exacerbations were treated for two weeks with netilmicin combined by randomisation with either azlocillin or ticarcillin. Other aspects of therapy were constant. The two therapy groups were comparable in all aspects. Both regimens produced similar improvements in clinical, radiological, laboratory, bacteriological and pulmonary function measurements. Concentrations of sputum bacteria were significantly reduced; transient eradication was documented in 29% and correlated with antibiotic susceptibility of the initially isolated Pseudomonas strains. The highly dosed antibiotics were well tolerated and emergence of resistance was rarely observed. It is concluded that both antibiotic combinations are beneficial and safe in cystic fibrosis. Monitoring of such intensive hospital treatment must include multiple parameters.

Topics: Adolescent; Adult; Azlocillin; Child; Child, Preschool; Clinical Trials as Topic; Cystic Fibrosis; Drug Combinations; Female; Humans; Lung Diseases; Male; Netilmicin; Penicillins; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Function Tests; Ticarcillin

Eighty patients were treated with either amikacin or netilmicin in a prospective randomized study of serious gram-negative bacillary infections, including 11 due to gentamicin-resistant pathogens. Thirty-six treated with netilmicin and 35 treated with amikacin were evaluable for efficacy or toxicity, or both. The overall groups differed significantly only in age. There were no significant differences in efficacy of the two drugs. There were no statistically significant differences at the 95% level between the netilmicin group and the amikacin group with respect to nephrotoxic reactions (38 versus 28%, respectively) or ototoxic reactions (9 versus 25%, respectively). Further comparative trials of netilmicin and other aminoglycosides appear warranted before it is widely used.

Topics: Adult; Aged; Amikacin; Bacterial Infections; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Gentamicins; Humans; Kanamycin; Lung Diseases; Male; Middle Aged; Netilmicin; Sepsis; Urinary Tract Infections

A case of retroperitoneal pulmonary fistula caused by a neonatal adrenal abscess is reported. The adrenal abscess was diagnosed by means of needle aspiration which guided the choice of antibiotic therapy. The fistula was demonstrated by direct injection of contrast medium into the adrenal abscess. Treatment by needle aspiration of the adrenal abscess and intravenous antibiotics was successful.

Topics: Abscess; Adrenal Gland Diseases; Anti-Bacterial Agents; Bronchial Fistula; Cefotaxime; Cephalosporins; Contrast Media; Escherichia coli Infections; Fistula; Gentamicins; Humans; Infant, Newborn; Injections, Intravenous; Lung Diseases; Male; Needles; Netilmicin; Suction; Tomography, X-Ray Computed

The signs of pneumonic plague in sacred baboons infected by aerosol are: fever, hurried breathing, depression and constantly increasing bacteremia. Some infected animals isolate the plague microbes while coughing and thus could be a source of the infection. By the clinical and pathomorphological signs, pneumonic plague in sacred baboons is similar to that in humans which makes it possible to use the animals in the development of schemes for special prophylaxis and treatment of the disease. In efficacy estimation of antibacterial drugs sacred baboons should be infected by aerosol by highly virulent strains of Y. pestis in doses of 1.10(4)-1.10(5) live microbes. The treatment of the animals should be started from the moment of the rectal temperature increase to 39.5 degrees C or higher after collecting the blood specimens for the bacteriological tests. It was shown that a two-day course of the treatment with antibacterial drugs was not efficient in the animals with pneumonic plague. The use of streptomycin, gentamicin, netilmicin or ciprofloxacin for 7 days cured all the infected animals. The use of streptomycin in the therapeutic doses was not efficient in the animals whose blood specimens of 1 cm3 contained 4.10(4) or more plague microbes by the moment when the treatment was started.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Body Temperature Regulation; Ciprofloxacin; Drug Evaluation, Preclinical; Female; Gentamicins; Lung Diseases; Male; Monkey Diseases; Netilmicin; Papio; Plague; Streptomycin

The pharmacokinetics of netilmicin was studied in 14 patients with cystic fibrosis, aged 4-21 years (mean 16 years) during treatment of pulmonary exacerbations of pseudomonas infection. The patients received 24 courses of netilmicin (10 mg/kg/day) in combination with azlocillin (600 mg/kg/day), cefsulodin (200 mg/kg/day) or ceftazidime (150 mg/kg/day) for 9-14 days. Seven patients received two or three courses of different combinations. Serum and sputum concentrations of netilmicin were determined on day 2 and 6. Mean (+/- S.E.M.) trough serum values were 1.4 +/- 0.2 mg/l (same on day 2 and 6), peak values at 10 min 13.6 +/- 1.0 and 13.7 +/- 0.9 mg/l, and serum concentration at 1 h 7.5 +/- 0.6 and 7.5 +/- 0.5 mg/l, on days 2 and 6 respectively. The half-life was about 1 h. The pharmacokinetics did not differ on day 2 and 6. Sputum concentrations increased up to 2-3 h after administration, mean (+/- S.E.M.) peak values being 2.6 +/- 0.6 and 1.5 +/- 0.4 mg/l at day 2 and 6, respectively. The study shows that the pharmacokinetics of netilmicin was not influenced by different combinations with beta-lactams. All patients improved clinically, but pseudomonas growth was only reduced in nine courses. In one case transient resistance to netilmicin developed during the treatment. The clinical efficacy and tolerance were good and similar to those seen with combinations with other aminoglycosides.

Topics: Adolescent; Adult; Azlocillin; Cephalosporins; Child; Child, Preschool; Cystic Fibrosis; Female; Humans; Lung Diseases; Male; Netilmicin; Pseudomonas aeruginosa; Sputum