netilmicin and Respiratory-Tract-Infections

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

To compare the efficacy and safety of two aminoglycoside antibiotics, etimicin and netilmicin, in the treatment of bacterial infections.. A randomized, open label, controlled clinical trial was conducted for the treatment of 65 patients hospitalized with respiratory tract infections, urinary tract infections, and skin and tissue infections. Thirty-four patients received etimicin and thirty-one patients received netilmicin at a dose of 100 mg every 12 hours by intravenous infusion. The duration of treatment was 7-10 days in both groups.. 47 patients were enrolled in the etimicin group; 35 patients were assessable for safety and 34 patients were assessable for efficacy, 46 patients were enrolled in the netilmicin group; 32 patients were assessable for safety and 31 patients were assessable for efficacy. The results show that overall efficacy was 85.3% for the etimicin group and 83.9% for the netilmicin group, whereas bacterial clearance rates were 87.5% for the etimicin group and 89.7% for the netilmicin group. The incidence of adverse reactions was 8.6% (3/35) and 9.4% (3/32), respectively.. Etimicin and netilmicin were effective and safe for the treatment of respiratory tract infection, urinary tract infection, and skin and tissue infections. The results show there was no statistically significant difference between the two groups (P > 0.05).

Topics: Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Female; Humans; Male; Middle Aged; Netilmicin; Respiratory Tract Infections; Skin Diseases, Bacterial; Urinary Tract Infections

Seventeen cystic fibrosis patients aged 3.1 years to 19.8 years had 30 courses of intensive treatment for relapse of their pseudomonas chest infection. The combination of netilmicin and ticarcillin was compared with tobramycin and ticarcillin in an open study. A significant subjective and objective improvement occurred in all patients. Pseudomonas was cleared temporarily from the sputum in 11 out of the 30 courses of treatment (37%). There was no significant difference between the netilmicin and tobramycin groups, nor evidence of sustained renal or ototoxicity. Intensive therapy of pseudomonas chest infection in cystic fibrosis patients is described in detail.

Topics: Adolescent; Adult; Child; Child, Preschool; Clinical Trials as Topic; Cystic Fibrosis; Drug Combinations; Female; Gentamicins; Humans; Lung Volume Measurements; Male; Netilmicin; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Sputum; Ticarcillin; Tobramycin

Netilmicin is active in vitro against a wide variety of gram-negative bacteria, including certain gentamicin-resistant isolates, and Staphylococcus aureus. This study presents the results of a prospective, randomized, double-blinded protocol designed to determine the relative efficacy and toxicity of netilmicin and gentamicin in the therapy of gram-negative infections. The demographic make-up of both treatment groups was similar. Cure rates were 96.7 percent with netilmicin and 94.4 percent with gentamicin. Possible transient nephrotoxicity developed in nine patients receiving netilmicin and in eight patients receiving gentamicin.

Topics: Adult; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Gentamicins; Gram-Negative Bacteria; Humans; Netilmicin; Random Allocation; Respiratory Tract Infections; Urinary Tract Infections

Thirty children with serious gram-negative infections were treated with either netilmicin, 2 mg/kg, or tobramycin, 1 mg/kg, every eight hours for a minimum of 72 hours. Because of the administration of different doses, a "blind" investigator evaluated treatment response while another investigator adjusted the doses on the basis of each patient's drug serum levels and bacteriological response. Comparisons between the two study groups showed both treatments to be equally effective. All 15 patients treated with netilmicin and 14 of the 15 patients treated with tobramycin experienced complete resolution of clinical signs and symptoms and elimination of pathogens. One child in the tobramycin group was considered a treatment failure because of a persistent urinary tract infection. There were no adverse effects attributable to either drug.

Topics: Anti-Bacterial Agents; Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Escherichia coli Infections; Female; Gentamicins; Humans; Male; Netilmicin; Respiratory Tract Infections; Tobramycin; Urinary Tract Infections

Topics: Adult; Aged; Bronchitis; Clinical Trials as Topic; Double-Blind Method; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Pneumonia; Respiratory Tract Infections; Sisomicin

Netilmicin is a new semisynthetic aminoglycoside which was developed by Schering Corporation, USA, for the treatment of serious gram-negative and staphylococcal infections. Nephrotoxicity and ototoxicity in animal studies have indicated that netilmicin is both quantitatively and qualitatively safer than other aminoglycosides. Also, netilmicin has a broader spectrum of activity than either gentamicin or tobramycin. 37 clinical studies were conducted by 29 investigators in 10 countries. 840 courses of treatment in 960 infection sites were analyzed for effectiveness. Of the 724 courses in which a clinical determination could be made, 91% had either complete resolution or improvement. Bacteriologic responses were available for 782 infecting organisms and showed an 82% elimination rate. The pharmacokinetic profile of netilmicin permits twice daily administration in most patients with systemic infections and in all patients with urinary tract infections. The clinical safety of netilmicin was measured in 890 evaluable treatment courses, and only 0.4% auditory reactions, 0.6% vestibular reactions, and 0.9% renal reactions were considered to be probably netilmicin related, when netilmicin was given as recommended.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Gentamicins; Hearing Loss; Humans; Infant; Infant, Newborn; Kidney; Male; Middle Aged; Netilmicin; Respiratory Tract Infections; Skin Diseases, Infectious; Urinary Tract Infections

To evaluate the clinical effects, pharmacokinetics, post-antibiotic effect (PAE) and toxicity of netilmicin as a single daily dose in the treatment of lower respiratory tract infection.. 48 cases were divided into 3 groups: In the first group, Netilmicin(6 mg.kg-1.d-1) was administered in a single daily dose; in the second group, netilmicin (200 mg/d) was combined with cefazolin (3 g, Q12 h); and in the third control group, the combination of cefazolin and Amikacin was used. Pharmacokinetics were studied in 7 patients using the TDX system, and PAE induced by Netilmicin was determined by the Avantage microbiologic system. Clinical symptoms, laboratory studies, chest X-rays, and side effects were observed.. The overall clinical effects of the first group were better than those of the third group. The mean serum concentration of netilmicin was 27.23 mg/L, the valley serum concentration was 0.23 mg/L, T1/2 beta was 5.059 h, AUC was 70 micrograms.h-1.ml-1.netilmicin at concentrations 0.5, 1.0 and 4 times the MIC showed different degrees of PAE against 4 strains of bacterium. Nephrotoxicity and ototoxicity were not found in the treatment group.. Netilmicin in a single daily dose resulted in a high peak serum concentration and big AUC. As a concentration-dependent bactericidal agent, netilmicin showed a longer PAE and better therapeutic effects.

Topics: Amikacin; Anti-Bacterial Agents; Cefazolin; Cephalosporins; Drug Therapy, Combination; Female; Gentamicins; Humans; Kidney; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Respiratory Tract Infections; Treatment Outcome

In 40 patients with bacterial bronchopulmonary complications during polychemotherapy for advanced bronchogenic carcinoma, once-daily netilmicin (4.5 mg/kg every 24 h) brought about complete resolution of the infective process in 90% of the cases and eradication of the responsible pathogen in 82%. This result must be considered good in view of the patients' precarious condition due to their advanced neoplastic disease.

Topics: Adult; Aged; Carcinoma, Bronchogenic; Drug Evaluation; Female; Humans; Lung Neoplasms; Male; Middle Aged; Netilmicin; Respiratory Tract Infections

Respiratory tract infections in intensive care units have a high fatality rate, perhaps as a result of the poor diffusion into bronchial secretions of aminoglucosides given by a systemic route. Endotracheal administration of aminoglycosides has been advocated but the optimal dosage remains to be determined. To investigate this problem we studied 13 patients free of renal failure and 6 patients with renal failure. Netilmicin was given by continuous endotracheal infusion in a daily dosage of 3 to 30 mg/kg. A good correlation was found between infused doses and serum concentrations; very high bronchial secretion concentrations were consistently found. There is a significant risk of accumulation in patients with renal failure. The characteristics of the respiratory tract secretions had no influence on the passage of netilmicin into the bloodstream. The dosages we advocate on the basis of our results are 8 mg/kg/day in patients free of renal failure and 4 mg/kg/day in patients with renal failure; serum netilmicin concentrations should not exceed 1 microgram/ml.

Topics: Adult; Aged; Aged, 80 and over; Bronchi; Female; Humans; Kidney Diseases; Male; Middle Aged; Netilmicin; Respiratory Tract Infections; Trachea

Netilmicin (NTL), a new semisynthesized aminoglycoside, was evaluated in 11 episodes of infection in 10 patients, who had severe underlying diseases, such as acute myocardial infarction, cerebral infarction, malignancy and hepatic cirrhosis. The infection was bacteremia in 3 cases, urinary tract infections in 3 cases and respiratory tract infections in 5 cases. NTL was administered intramuscularly at a dose of 100 mg twice a day for 3 to 14 days. Overall clinical efficacy was only 40%, including excellent in 2 cases, good in 2 cases, fair in 3 cases and poor in 3 cases. Bacteriologically, 2 episodes of E. coli, 2 of S. marcescens and 1 of K. pneumoniae were eradicated, whereas, 2 of P. aeruginosa were decreased, and 1 of K. pneumoniae and 1 of P. rettgeri were persisted. Transient eosinophilia was observed in 1 case, and also nephrotoxicity was encountered in 1 case.

Topics: Aged; Bacteria; Drug Evaluation; Drug Resistance, Microbial; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Aminoglycosides are often used in the treatment of severe Gram-negative infections, particularly those involving the respiratory tract. The purpose of this study was to evaluate the penetration of netilmicin into bronchial secretions. In 8 tracheostomized patients samples of bronchial secretions were taken at intervals through the tracheostomy cannula after intramuscular injection of netilmicin 2 mg/kg bodyweight. Concentrations of the drug were measured in bronchial secretions and in blood samples taken simultaneously, using the agar diffusion method (Grove and Randall procedure). The results showed significant penetration of netilmicin, with a mean bronchial peak reaching 3.4 micrograms/ml 1 h after the injection. Elimination was slow, with a mean residual level of 2 micrograms/ml at 6 hours. The bronchial to serum levels ratio was high (greater than 30% at 1 hour). Individual variations in both serum and bronchial levels were noted; they were unrelated to the underlying pathology. However, changes in bronchial concentrations correlated with changes in serum concentrations, which suggests passive diffusion across the blood-bronchoalveolar barrier. The fluctuations in bronchial levels and the usually low bronchial concentrations of aminoglycosides previously reported are discussed in relation to the methods used.

Topics: Adult; Aged; Bronchi; Gentamicins; Humans; Immunodiffusion; Male; Middle Aged; Netilmicin; Respiratory Tract Infections; Time Factors

Topics: Adult; Aged; Bacterial Infections; Drug Evaluation; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Respiratory Tract Infections

To 10 cases with respiratory infections, 200 mg, twice daily, of netilmicin was administered without other antibiotics and the following results were obtained. 1) Netilmicin was administered to 2 cases of pneumonia and 8 cases of bronchitis for 7 to 30 days, and 4 remarkably effective and 6 effective cases were observed, that is, netilmicin was effective in all cases. 2) Abnormal laboratory test values were found in 2 cases; 1 case showed slightly elevated creatinine value, and 1 case showed slightly increase GTP value, and these values were normalized rapidly without any treatment after discontinuation of netilmicin administration. Netilmicin 100 mg was intramuscularly injected to 15 patients with pleural effusion to see the time-course distribution of the drug to serum and to pleural fluid by determining the concentration of netilmicin. 1) Netilmicin concentrations in serum reached the peak at 30 minutes after the intramuscular injection and it gradually decreased, while in the pleural fluid, it reached the peak at 3 hours after the injection, and the peak value in the pleural fluid in average was 2.63 +/- 1.98 micrograms/ml, and it was still detectable at 24 hours after the injection. 2) The ratio of netilmicin concentrations in the serum and pleural fluid at the peak was 31.7 +/- 23.4%, and distribution of netilmicin into the pleural fluid was considered to be high enough.

Topics: Adult; Aged; Drug Evaluation; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Pleural Effusion; Respiratory Tract Infections

Twenty patients with a variety of serious or difficult infections and 5 additional orthopaedic patients with clinical evidence of post-operative wound infection were treated with netilmicin. The results indicate that twice daily dosage with 150 mg intramuscularly, either alone or in combination with other antibiotic therapy, was highly effective. Overall, 25 (96%) infections responded clinically and 19 (73%) were improved bacteriologically. There was no evidence of ototoxicity: a number of patients had impaired renal function which developed during therapy, but all returned to normal or pre-treatment levels by the time that treatment was completed, despite the fact that 15 patients were receiving diuretics. It is suggested in view of its effectiveness, more predictable serum levels after standard dosage and apparent lack of toxicity, that netilmicin should be considered as the first choice aminoglycoside antibiotic instead of gentamicin.

Topics: Adult; Aged; Bacterial Infections; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Respiratory Tract Infections; Urinary Tract Infections; Wound Infection

Netilmicin, a new semisynthetic aminoglycoside antibiotic recently developed by Shering Co., was injected to 5 patients with respiratory tract infection (2 cases of diffuse panbronchiolitis, 2 cases of bronchiectasis and 1 case of bronchial asthma with infection). A daily dose of netilmicin was 200 mg by intramuscular injection and duration of netilmicin therapy was for 7 to 14 days. Clinical response to netilmicin therapy of respiratory tract infection was good in 3 cases, fair in 1 case and poor in 1 case. No subjective and objective findings considered as the side effect was observed and laboratory examinations showed no abnormality. It may be concluded from the above clinical results that netilmicin may be effective for respiratory tract infections and further study may prove its efficacy.

Topics: Adult; Aged; Drug Evaluation; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Respiratory Tract Infections

Topics: Adult; Aged; Drug Resistance, Microbial; Enterobacteriaceae Infections; Gentamicins; Humans; Kidney Diseases; Male; Middle Aged; Netilmicin; Pseudomonas Infections; Respiratory Tract Infections; Sepsis; Urinary Tract Infections