netilmicin and Staphylococcal-Infections

In a pilot double-blind, randomized, prospective controlled study the effectiveness and safety of 0.3% netilmicin ophthalmic solution were compared with those of 0.3% tobramycin in treating external bacterial ocular infections in 45 eligible patients. The treatment with both study medications resulted in a significant (p < 0.001, Wilcoxon test) reduction in the mean cumulative score of the signs and symptoms. However, no statistically significant differences were observed between the two groups. The clinical improvement rate was almost complete with either antibiotics. There was a statistically positive trend in the netilmicin group with regard to the microbiological improvement that was achieved in (87% of the netilmicin patients) compared with 77% of the tobramycin patients (77%). Antibiotic sensitivity revealed that 84% of the organisms isolated were sensitive to netilmicin whereas only 64% of them were sensitive to tobramycin. Only minor adverse events occurred in patients treated with either netilmicin or tobramycin. In conclusion, this study demonstrates that netilmicin is a promising new antibiotic for treating external ocular infections.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Conjunctivitis, Bacterial; Double-Blind Method; Drug Resistance, Microbial; Female; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Netilmicin; Staphylococcal Infections; Staphylococcus aureus; Tobramycin; Treatment Outcome

Twenty-eight patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were clinically studied for the effectiveness of the time-difference combination use of netilmicin (NTL) and minocycline (MINO). The patients were treated with NTL 100 mg and two hours later, with MINO 100 mg intravenously, twice daily, in the morning and evening for 14 days. Of 26 patients, MRSA was eradicated in 16 (61.5%), decreased in one, and unchanged in nine. Superinfections occurred with Serratia marcescens and Pseudomonas aeruginosa in two patients. The clinical efficacies were assessed in two patients with septicemia, 16 with pneumonia, and eight with chronic bronchitis. The obtained results were excellent in four patients, good in 15, fair in six, and poor in one patient. The rate of effectiveness was 73.1% (19/26). The overall clinical effectiveness judged by the committee was good in 19, fair in five, and poor in two patients. The efficacy rate was also 73.1% (19/26). Coagulase type II of MRSA was found in 23 patients, and coagulase type III in three patients, with overall clinical efficacy rates of 73.9% (17/23) and 66.7% (2/3), respectively. A side effect of eruption was observed in one patient, and its incidence was 3.6% (1/28). Abnormal laboratory test results were observed in 16 patients (57.1%), including abnormal liver function in 14 patients, abnormal kidney function in three, and increased eosinophils in three. Laboratory abnormalities occurred twelve of 16 bedridden patients, and this rate was higher than that in non bedridden patients. However, these abnormalities were all mild, transient, and immediately recovered after the treatment. In conclusion, the time-difference combination therapy using NTL and MINO was effective in the treatment of MRSA infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bronchitis; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Japan; Male; Methicillin Resistance; Middle Aged; Minocycline; Netilmicin; Pneumonia, Staphylococcal; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Superinfection

Twenty one patients with serious Staphylococcus aureus infection and bacteraemia were randomized prospectively to receive either teicoplanin and netilmicin or flucloxacillin and netilmicin. After at least 48 h of treatment serum samples were collected for the determination of trough and peak antibiotic concentrations, the serum killing level and the serum bactericidal rate. With the help of a severity-of-disease scoring system (APACHE II) the clinical efficacy of antimicrobial therapy was assessed. Eighteen patients were evaluable. The clinical results and the results of the serum assays suggest that treatment with teicoplanin or flucloxacillin, combined with netilmicin, is a safe approach in patients with bacteraemia caused by S. aureus.

Topics: Adult; Cloxacillin; Drug Therapy, Combination; Floxacillin; Glycopeptides; Humans; Microbial Sensitivity Tests; Netilmicin; Sepsis; Staphylococcal Infections; Teicoplanin

93 patients were enrolled into a prospective randomised study to determine the efficacy and safety of netilmicin, cefotaxime or their combination in the treatment of sepsis caused by susceptible strains of Enterobacteriaceae or staphylococci. 83 patients were evaluable for safety, 74 for clinical efficacy and 63 for microbiological response including 36 patients (57%) with positive blood cultures. There were significantly more clinical failures with cefotaxime than with netilmicin even when urinary tract sepsis was excluded. Microbiological failures occurred more frequently in the cefotaxime arm and were associated with Klebsiella and Enterobacter spp. Four cefotaxime failures were subsequently successfully treated with netilmicin. More mixed infections were however enrolled by chance into the cefotaxime arm. The statistical difference between netilmicin and cefotaxime is not significant if mixed infections are excluded. There was no difference in efficacy between the netilmicin and combination groups although superinfection was seen in the latter group. The incidence of nephrotoxicity was greater in the netilmicin group but not significantly so. Only one minor case of ototoxicity was detected in the 41 patients receiving netilmicin who had serial audiograms. The results suggest that netilmicin is a more effective agent than cefotaxime for treating life-threatening infections with susceptible Enterobacteriaceae or staphylococci particularly with infections in non-urinary tract sites. If dosage of netilmicin is closely monitored by measuring serum concentrations, toxicity is minimal.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Netilmicin; Random Allocation; Sepsis; Staphylococcal Infections

During a randomized clinical trial comparing tobramycin plus ticarcillin to netilmicin plus ticarcillin as empiric therapy of febrile neutropenic patients, Staphylococcus epidermidis emerged as the predominate superinfecting pathogen in tobramycin recipients. Overall clinical response was 68% (44/65 responding) in tobramycin/ticarcillin recipients and 73% (45/62) in netilmicin/ticarcillin recipients. However, 5/65 tobramycin/ticarcillin treated episodes were complicated by bacteremic superinfection with Staphylococcus epidermidis, as compared to 0/62 netilmicin/ticarcillin treated episodes (p less than 0.05). Four of the five bacteremic strains produced aminoglycoside adenylating enzyme ANT 4', 4''. Prior colonization of patients with identical strains was demonstrated by plasmid profile analysis, antibiograms and biotyping with the API Staph-Ident system. During the trial, 36 consecutive patients were studied for colonization patterns with coagulase-negative staphylococci. S. epidermidis accounted for 566/831 (68%) isolates of coagulase-negative staphylococci recovered from surveillance cultures. Tobramycin-resistant strains were acquired in 2/17, 4/12 and 9/14 patients during trimethoprim/sulfamethoxazole, netilmicin/ticarcillin and tobramycin/ticarcillin therapy, respectively. Prior to aminoglycoside therapy, 77% of strains were susceptible to less than or equal to 8 micrograms/ml of tobramycin, but only 35% and 28% were susceptible to tobramycin after initiation of tobramycin/ticarcillin and netilmicin/ticarcillin therapy, respectively. In contrast, greater than or equal to 93% of isolates were susceptible to netilmicin before and after aminoglycoside therapy. Absence of several sites susceptible to modification by aminoglycoside inactivating enzymes produced by staphylococci may give netilmicin a therapeutic advantage in the therapy of febrile neutropenic patients.

Topics: Adult; Agranulocytosis; Aminoglycosides; Clinical Trials as Topic; Cross Infection; Drug Therapy, Combination; Ear; Humans; Kidney; Netilmicin; Neutropenia; Penicillin Resistance; Random Allocation; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis; Ticarcillin; Tobramycin

Women with uncomplicated urinary tract infections were randomly allocated to either a single 150 mg intramuscular dose of netilmicin or a standard five-day course of oral co-trimoxazole. Twenty-one of 22 were cured with netilmicin and all 20 with co-trimoxazole. No patient treated with netilmicin developed any side effects or obvious toxicity. Following co-trimoxazole one woman developed a severe skin rash and another nausea. Netilmicin is another drug which is highly effective when used in a single dose regimen for the treatment of uncomplicated urinary tract infections. There are many advantages of this approach to the management of a common clinical problem.

Topics: Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Female; Gentamicins; Humans; Injections, Intramuscular; Middle Aged; Netilmicin; Prospective Studies; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study.. Standard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30 μg, netilmicin 30 μg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24 h, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines.. Vancomycin induced a halo of 22.37 mm and 21.81 mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45 mm in SAu and 32.49 mm in CoNS. MeAl induced halos of 12.65 mm in SAu and 15.83 mm in CoNS. A 12.11 mm halo was found in SAu and an 18.38 mm halo in CoNS using HOCl. DGCH produced halos of 26.55 mm and 23.12 mm in SAu and CoNS, respectively.. Netilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy.

Topics: Anti-Bacterial Agents; Blepharitis; Humans; Microbial Sensitivity Tests; Netilmicin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Vancomycin

Aminoglycoside resistance (AR) is common in health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA). AR is most often associated with the production of antibiotic modifying enzymes: bidomain AAC(6')-Ie/APH(2″)-Ia acetyltransferase and phosphotransferase, ANT(4')-Ia nucleotidyltransferase, and APH(3″)-IIIa phosphotransferase.. Determination of aminoglycoside sensitivity, presence of genes encoding enzymes, and molecular typing of HA-MRSA strains derived from patients hospitalized in surgical and transplantation wards.. Fifty-four HA-MRSA strains, isolated from various materials from patients in the surgical and transplantation wards of Warsaw's clinical hospital, hospitalized between 1991 and 2007. The MIC values of gentamicin-GEN/tobramycin-TOB/amikacin-AK/netilmicin-NET were determined by the E-test (CLSI/EUCAST). Genes mecA/aacA-aphD/aadD/aph(3″)-IIIa were detected using PCR. SCCmec types were determined according to the Oliveira method and the sequence type (ST)/clonal complex (CC) by the MLST method.. Of the isolates tested, 36 (66.7%) showed resistance to at least one aminoglycoside: TOB (57.4%), GEN (53.7%), AK (55.6%), NET (24.1%). The aacA-aphD gene was present in 29 MRSA-GEN-R (most often in combination with aadD, 15/29 or aph(3″)-IIIa, 10/29); the aacA-aphD gene was the only determinant of resistance in 1 isolate. The AR variants mainly belonged to the CC8 clonal complex (ST239/247/241/254/8) and most frequently contained SCCmec type III (3A) cassettes.. Resistance to at least one aminoglycoside was present in 66.7% of HA-MRSA and in more than 22% to all of them. The presence of the aacA-aphD gene was sufficient to express the resistance phenotype to GEN/TOB/AK/NET. Resistant isolates were closely related to each other.

Topics: Amikacin; Aminoglycosides; Anti-Bacterial Agents; Bacterial Proteins; Gentamicins; Hospital Units; Hospitals; Humans; Kanamycin Kinase; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Netilmicin; Nucleotidyltransferases; Penicillin-Binding Proteins; Retrospective Studies; Staphylococcal Infections; Tobramycin

The clinical isolates of Staphylococcus aureus (n = 102) were analyzed on sensitivity and to gentamicin, tobramicin, netimicin and amikacin. The disc diffusing technique was applied. The technique ofpolymerase chain reaction was applied to analyze all strains establishing presence in their genomes genes aac (6'-Ie/aph(2"), ant1, aac, ant(6)-Ia, aph (3')-IIIa and ant(4')-Ia coding amino-glycoside-modifying enzymes. The strains sensitive to amino-glycosides had no the given genes in genome. The genome of all strains resistant to amino-glycosides included no less than two of enumerated genes. The 100% correlation was established between phenotypic resistance of analyzed strains to amino-glycosides and availability in them of gene aac(6')-Ie/aph(2").

Topics: Acetyltransferases; Amikacin; Anti-Bacterial Agents; Bacterial Typing Techniques; Biotransformation; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Gene Dosage; Gene Expression; Genes, Bacterial; Genome, Bacterial; Genotype; Gentamicins; Hospitals; Humans; Netilmicin; Orthopedics; Phenotype; Phosphotransferases (Alcohol Group Acceptor); Russia; Staphylococcal Infections; Staphylococcus aureus; Tobramycin

To report clinical manifestations of a female patient with bilateral bacterial keratitis following photorefractive keratectomy (PRK). Bilateral PRK was performed for moderate hyperopia. Bandage contact lenses were fitted at the conclusion of the surgery. Bilateral infectious keratitis with hypopion was diagnosed within 4 days after surgery. Smear and culture were obtained and showed the presence of methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated with systemic prednisone and topical antibiotics (vancomycin, tobramycin and netylmicin) and betamethasone. After 1 month corneal leukoma was still present and remained unchanged during the following 7 months. Infectious keratitis is a rare complication of PRK that appears early in the postoperative period. MRSA keratitis may determine long-term visual impairment despite prompt therapeutic intervention.

Topics: Anti-Infective Agents; Antitubercular Agents; Aza Compounds; Diagnosis, Differential; Dose-Response Relationship, Drug; Female; Fluoroquinolones; Follow-Up Studies; Humans; Hyperopia; Keratitis; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Moxifloxacin; Netilmicin; Ophthalmic Solutions; Photorefractive Keratectomy; Quinolines; Staphylococcal Infections; Visual Acuity

Topics: Amikacin; Anti-Bacterial Agents; Drug and Narcotic Control; Humans; Infant, Newborn; Medical Audit; Netilmicin; New Zealand; Retrospective Studies; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptococcus agalactiae; Treatment Failure

We report the results of a microbiological clinic study that was performed by our ENT Department between years 2000 and 2001 whose main objective was to determine, in Badajoz Area of Health, which bacteria were involved in the acute diffuse external otitis of patients without previous antibiotic treatment (two weeks before obtaining the samples). Of 79 isolated microorganisms in 62 patients that fulfilled the requirements established Pseudomonas, mainly P. Aeruginosa, represented a 46.83% altogether followed by Staphylococcus (18.98%). In almost one fourth part of the cases strains of associated fungi were identified.

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Ciprofloxacin; Data Interpretation, Statistical; Female; Fungi; Humans; Male; Middle Aged; Mycoses; Netilmicin; Otitis Externa; Prevalence; Pseudomonas aeruginosa; Pseudomonas Infections; Sex Factors; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Treatment Outcome

Infection can be a devastating complication after implantation of a cortical bone allograft. The allograft could act as a vehicle for local antibiotic prophylaxis.. We studied the release of antibiotics in vitro from cortical bone allografts impregnated with antibiotics for different periods of time. We also studied whether cortical allografts impregnated with antibiotics could eradicate Staphylococcus aureus from an experimentally infected graft in vivo. In the in vitro study, pieces of cortical bone were impregnated with netilmicin, vancomycin, ciprofloxacin and rifampicin for 1 h, 10 h and 100 h. The antibiotics were eluted into phosphate-buffered saline (PBS) for 7 days, with daily transfer of the bone into fresh PBS. In the in vivo study, cortical allografts impregnated with antibiotics were placed in rats intramuscularly. 10 microL of an S. aureus suspension (0.6 x 10(5) CFU) was placed in the intramedullary cavity. After 15 days, the allografts were removed and examined for bacterial growth.. The amount of antibiotics released in vitro was influenced by the time used for antibiotic impregnation of the bone. Allografts impregnated with netilmicin, vancomycin and rifampicin effectively eradicated perioperative contamination with S. aureus in vivo.. This study shows that a cortical bone allograft would be an effective vehicle for local antibiotic delivery.

Topics: Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bone Transplantation; Femur; Netilmicin; Postoperative Complications; Rats; Rats, Wistar; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Transplantation, Homologous; Vancomycin

Once-daily administration of aminoglycoside antibiotics has become the most acceptable dosing schedule for the majority of patients. There are few published data on the impact of post-natal age on aminoglycoside concentrations in preterm infants receiving once-daily dosage regimens. Netilmicin was administered as a once-daily dose of 4 mg/kg. In 141 episodes of suspected sepsis in 123 babies, trough netilmicin concentrations ranged from undetectable to 4.0 mg/l. Netilmicin concentrations were above a level of 2 mg/l in 10.6% of episodes. Netilmicin concentrations decreased with increasing post-natal age and weight. Levels were higher in males compared to females. Increased creatinine concentrations were associated with higher netilmicin concentrations. This study emphasises the importance of post-natal age as a determinant of aminoglycoside concentrations with a once-daily dosing regimen in a neonatal intensive care population. Trough levels should be carefully monitored and consideration given to extending dosage intervals particularly when netilmicin is administered once daily to preterm infants in the first week of life.

Topics: Aging; Anti-Bacterial Agents; Audiology; Body Weight; Creatinine; Enterobacteriaceae Infections; Enterococcus; Escherichia coli Infections; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intensive Care, Neonatal; Linear Models; Male; Netilmicin; Retrospective Studies; Sepsis; Staphylococcal Infections; Streptococcal Infections

This article describes three extremely low birth weight infants with Staphylococcus aureus septicemia associated with insertion of a percutaneous central venous catheter who later developed endocarditis. Echocardiography demonstrated large vegetations although only one infant had a murmur. Following a 6-week course of intravenous flucloxacillin and netilmicin, the endocarditis completely resolved and further intervention was unnecessary, although one baby died later as a result of volvulus and chronic lung disease. Echocardiography should be performed to exclude invasive infection in infants with S. aureus septicemia even when there is no murmur or other evidence of endocarditis. If endocarditis is identified, a good outcome is possible with appropriate aggressive antibiotic therapy.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Endocarditis, Bacterial; Female; Floxacillin; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Male; Netilmicin; Staphylococcal Infections; Staphylococcus aureus; Ultrasonography

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

In the present study MRSA prevalence increased from 12% in 1992 to 80.83% in 1999. Indian literature shows that MRSA incidence was as low as 6.9% in 1988 and reached to 24% and 32.6% in Vellore and Lucknow in 1994 and was of the same order in Mumbai, Delhi and Bangalore in 1996 and in Rohtak and Mangalore in 1999. However, in some of the centres it was as high as 87%. All the MRSA isolates in India including in the present study were sensitive to vancomycin and resistance to netilmycin appears to be low among MRSA isolates in India. All the MRSA isolates were also found to be sensitive to teicoplanin in the present study. Like in other Indian studies, resistance to cotrimoxazole, erythromycin, gentamicin, other penicillins and cephalosporins appeared to be a common feature for MRSA isolates in the present study.

Topics: Animals; Anti-Bacterial Agents; Cross Infection; Humans; India; Methicillin Resistance; Microbial Sensitivity Tests; Netilmicin; Prevalence; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Gentamicins; Humans; Microbial Sensitivity Tests; Netilmicin; New Zealand; Staphylococcal Infections; Staphylococcus

Topics: Gentamicins; Humans; Microbial Sensitivity Tests; Netilmicin; Staphylococcal Infections; Staphylococcus; Treatment Outcome

Topics: Gentamicins; Humans; Netilmicin; Staphylococcal Infections; Staphylococcus

Using a rabbit model of aortic valve endocarditis, we studied the efficacy of vancomycin alone or in combination with netilmicin and/or rifampin against a methicillin- and gentamicin-resistant strain of Staphylococcus aureus (MGRSA). Antibiotics were given for 6 to 12 days, as follows: vancomycin (15 mg/kg of body weight every 12 h [BID] intravenously), vancomycin plus netilmicin (2.5 mg/kg BID intramuscularly), vancomycin plus rifampin (10 mg/kg BID intramuscularly), and vancomycin plus netilmicin plus rifampin at the same routes, dosages, and schedules mentioned above. Netilmicin was given to two additional groups at a higher dosage (6 mg/kg every 24 h intramuscularly) alone or in combination with vancomycin (15 mg/kg BID intravenously) for 12 days. All regimens resulted in undetectable bacterial counts in a significant proportion of vegetations (except netilmicin alone) or reduced the bacterial counts in the vegetations compared with the counts in the untreated controls (P<0.01 to P<0.001). No resistance to rifampin or netilmicin developed during therapy. It is concluded that in the treatment of experimental aortic valve endocarditis caused by MGRSA (i) vancomycin as monotherapy is as efficacious as the triple combination, (ii) the addition of netilmicin (once daily or BID) to vancomycin does not improve the efficacy of the latter antibiotic, even in the presence of rifampin, and (iii) a 12-day course in more effective than a 6-day one, but not at a statistically significant level.

Topics: Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Methicillin Resistance; Microbial Sensitivity Tests; Netilmicin; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

A sixteen year old female was feverish from June 12, 1993. Methicillin-resistant Staphylococcus aureus was isolated from the blood, the diagnosis of MRSA sepsis was established. Vancomycin (2 g/day) was administered for eighteen days, but MRSA was not eradicated in the blood culture. Then she was administered a combination therapy of arbekacin (200 mg/day) and imipenem/cilastain (1 g/day) for seven days, but MRSA in the blood was cultured continuously. The sequential combination therapy of netilmycin (200 mg/day) and minocycline (200 mg/day) was started, MRSA was eradicated from the blood culture after four days. The sequential combination therapy netilmycin and minocycline was seemed to be effective for MRSA infection.

Topics: Adolescent; Bacteremia; Drug Therapy, Combination; Female; Humans; Methicillin Resistance; Minocycline; Netilmicin; Staphylococcal Infections; Staphylococcus aureus

The bactericidal activities of arbekacin (ABK), vancomycin (VCM), gentamicin (GM) and netilmicin (NTL) in mixed culture with Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were examined using an in vitro computer programmed pharmacokinetic simulation system and also the protective effect of these agents on systemic infection in neutropenic mice was examined. In a mixed culture of S. aureus No. 235 (MRSA) and P. aeruginosa E7, ABK showed a strong bactericidal activity and an inhibition of regrowth against both bacteria, and GM and NTL showed similar effects. On the other hand, VCM showed a bactericidal activity against S. aureus No. 235, but not against P. aeruginosa. In the protective study, ABK was evidently more effective than GM, NTL or VCM against a systemic mixed infection of mice with S. aureus No. 235 and P. aeruginosa E7. In brief, the ED50 values of ABK, VCM, GM and NTL were 19.5, > 100, 40.5 and 45.2 mg/kg, respectively.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Computer Simulation; Dibekacin; Gentamicins; Male; Methicillin Resistance; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Netilmicin; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

To investigate at what time the peak level should be determined under conventional thrice daily (t.i.d.) administration of the aminoglycoside netilmicin and to study its serum concentrations under once daily (od) treatment to define the required daily dose and to gain information about convenient drug monitoring.. The design of the study was a consecutive sample trial.. The study took place in a university hospital.. 41 intubated patients of a surgical ICU who received netilmicin as a short-term infusion over 30 min for life-threatening infections were included in the study.. In 21 patients netilmicin was administered t.i.d. The virtual peak levels which had been determined by pharmacokinetic dosage calculation were compared with the serum concentrations obtained directly after the administration as well as after 15, 30, 60 and 180 min. In 20 patients the netilmicin serum concentrations during od treatment were determined directly before and immediately after the application as well as 0.5, 1, 3, 7 and 12 h later. To achieve a virtual peak level of 25 mg/l and a trough level of 0.5 mg/l individual adjustment of the dosage based on pharmacokinetic calculations was performed.. In t.i.d. treatment the serum concentration measured after 30 min was closest to the virtual peak level; therefore, this is the best time to determine the peak level. In od treatment the required daily dose was 7.86 mg/kg body weight (median) in patients with normal renal function. During od dosing the trough level was extremely important in drug monitoring, whereas determination of the high peak level was of doubtful value.. The peak level should be determined during t.i.d. administration at 30 min. In od treatment the initial daily dose should be 7 mg/kg body weight; in drug monitoring the trough level is very important.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fosfomycin; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Intensive Care Units; Male; Metabolic Clearance Rate; Metronidazole; Middle Aged; Netilmicin; Piperacillin; Respiration, Artificial; Staphylococcal Infections; Teicoplanin

This study compared co-amoxiclav, vancomycin and teicoplanin with and without netilmicin or amikacin for treating experimental subcutaneous fibrin-clot infection in rabbits due to a clinical beta-lactamase-positive methicillin- and gentamicin-resistant Staphylococcus epidermidis strain (MGRSE). MICs (mg/L) for this strain were: oxacillin 125, gentamicin 32, vancomycin 4, teicoplanin 8, netilmicin 1, amikacin 4, amoxycillin 64 with clavulanate at 2 mg/L. In rabbits treated with a single-dose i.v. regimen (netilmicin 8 mg/kg, amikacin 20 mg/kg, vancomycin 30 mg/kg, teicoplanin 15 mg/kg, co-amoxiclav 150-30 mg/kg), the bacterial count 24 h post-dose was reduced whatever the combination used (ANOVA, P < or = 0.001). Regimens were statistically classified in decreasing order of efficacy as follows: co-amoxiclav combined with netilmicin > vancomycin either alone or combined with either netilmicin or amikacin, teicoplanin with netilmicin > netilmicin and co-amoxiclav alone > teicoplanin or co-amoxiclav combined with amikacin, and teicoplanin alone > amikacin > no drug. From these findings, it is concluded that: co-amoxiclav could be useful for the treatment of beta-lactamase-positive and methicillin-resistant S. epidermidis infection; some enzyme-resistant aminoglycoside could be considered for treating gentamicin-resistant but netilmicin/amikacin-sensitive S. epidermidis infection; the combination of co-amoxiclav with netilmicin was synergistic and more rapidly bactericidal than vancomycin in this animal model.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Drug Combinations; Drug Resistance, Microbial; Gentamicins; Methicillin Resistance; Models, Biological; Netilmicin; Rabbits; Staphylococcal Infections; Staphylococcus epidermidis

Two combinations of antibiotics, clindamycin with rifampicin and cloxacillin with netilmicin, were investigated for their activity against two strains of Staphylococcus aureus (a sensitive reference strain and a methicillin-resistant clinical isolate) by means of the in vitro checkerboard technique and an in vivo infected mouse model. The mouse model allowed drug interactions to be evaluated both from the changes in the number of bacteria surviving treatment and from the measured exposure to antibiotics at the site of infection. Specimens from the latter were evaluated twice (day 0 and day 2) in each experiment. The combination of cloxacillin and netilmicin exhibited a synergistic effect against the reference strain both in vitro and in vivo, whereas synergism was obtained under in vitro conditions only against the methicillin-resistant strain. The clindamycin and rifampicin combination acted synergistically or indifferently against both strains in vitro and at day 0 of the in vivo experiments. In contrast, on day 2 of infection, this combination had significantly greater bactericidal effect (synergism) compared to the combination of cloxacillin and netilmicin. These results illustrate the difficulties of interpreting in vitro results for clinical use.

Topics: Animals; Clindamycin; Cloxacillin; Disease Models, Animal; Drug Interactions; Drug Therapy, Combination; Female; Humans; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Netilmicin; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Early onset prosthetic valve endocarditis is one of the most lethal complications after valve replacement. During the first year of operation of our new cardiac surgical program, we observed 10 cases of prosthetic valve endocarditis, the majority being caused by staphylococci, making an incidence of 10.6%. Subsequent investigations uncovered a very high prevalence of methicillin-resistant strains which led to a radical change in the antibiotic prophylaxis, from a cephalosporin-based protocol to a two drug regime of vancomycin and netilmicin. There were no cases of prosthetic infection among the 138 patients operated on in the one year period following the institution of this protocol. Because there were no other changes, either in the types of prostheses used or the techniques of implantation, the eradication of prosthetic valve endocarditis can be related only to this alteration in the prophylaxis. Therefore, we may conclude that the inter-institutional transfer of protocols is not adequate before a thorough investigation of the prevalent hospital pathogens and their sensitivity to antibiotics is carried out. We have not registered resistances to vancomycin and this drug remains the most important antimicrobial agent, both in the prophylaxis and in the treatment of prosthetic valve endocarditis.

Topics: Adult; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus epidermidis; Vancomycin

This study was undertaken to evaluate: 1. The efficacy of netilmycin and vancomycin as combined first line antimicrobial regime, compared to cefuroxime, in the treatment of peritonitis. 2. To measure the levels of netilmycin and vancomycin in the serum and dialysate. 3. To report on the use of this combination over a one year period and compare it with that of cefuroxime used during the previous one year.

Topics: Adult; Aged; Cefuroxime; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Netilmicin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Pilot Projects; Random Allocation; Staphylococcal Infections; Vancomycin

A total of 790 blood culture isolates was collected during 3 study periods in 1982/83, 1984/85 and 1987/88. Staphylococci were the most frequent bacteria in the first two periods (56.5% and 63%, respectively). During the last period, E. coli was the most frequent of all species (27%). Differences in the distribution of bacteria between the laboratories were considerable. In one laboratory in Vienna, coagulase-negative staphylococci dominated in all 3 study periods (32%, 33% and 47%). Susceptibility against gentamicin, tobramycin and netilmicin (MIC less than or equal to 4 mg/l), as well as against amikacin (MIC less than or equal to 8 mg/l) were determined by a microdilution method. The resistance rates against gentamicin (G) were 25%, 21% and 25%, against tobramycin (T) 27%, 19% and 25%, against netilmicin (N) 6%, 4% and 19%, and against amikacin (A), 5%, 2% and 19%. Most resistant strains were staphylococci (G 26%-41%, T 26%-46%, N 3%-31%, A 3%-36%), whereas gram-negative bacilli were more susceptible (G 12%-14%, T 7%-11%, N 7%-9%, A 1%-7.5%). The increase of resistance against netilmicin and amikacin in staphylococci was most striking. Nearly all those strain could be attributed to one laboratory in Vienna. Most of them were coagulase-negative staphylococci. In the first study period, the most frequent pattern was resistance against gentamicin and tobramycin, whereas in the last period resistance to all 4 aminoglycosides dominated. The study demonstrates considerable local differences in antibiotic resistance. Monitoring of antibiotic resistance in collaborative studies using standardized methods should be a valuable tool in planning strategies for controlling an epidemic spread of resistance.

Topics: Amikacin; Anti-Bacterial Agents; Austria; Drug Resistance, Microbial; Enterobacteriaceae; Escherichia coli; Gentamicins; Gram-Negative Bacteria; Humans; Netilmicin; Pseudomonas aeruginosa; Sepsis; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Tobramycin

A method is described to predict the efficacy of antibiotics at changing concentrations in vitro or in an experimental thigh infection in granulocytopenic mice from the activity at constant concentrations in vitro, using pharmacokinetic parameters. The combinations studied were erythromycin against Staphylococcus aureus (in vitro and in vivo), four cephalosporins against two Gram-negative rods (in vivo), netilmicin against Pseudomonas aeruginosa (in vitro) and vancomycin against S. aureus (in vivo). The effect in vitro (ER) was defined as the difference between the growth rate without antibiotic and the growth rate in the presence of an antibiotic. The relationship between concentration and ER was described with the Hill equation. Using pharmacokinetic parameters of exponentially declining concentrations in vitro or of a bi-exponential concentration course in vivo together with the parameters of the Hill equation, the corresponding time course of ER was calculated. By integration with respect to time, an estimate, called ERt, was obtained of the effect on bacterial numbers, called EN, defined as the difference between the number of bacteria in the controls and the number in the presence of the antibiotics. For all antibiotics studied the value of ERt was significantly correlated with the actual values of EN.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cephalosporins; Erythromycin; Gram-Negative Bacteria; Mice; Netilmicin; Pseudomonas aeruginosa; Regression Analysis; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

The case of a 22 years old patient, primigravida, who underwent cesarean for acute fetal distress, and who presented with, at the second day of puerperium, puerperal infection, with clinical picture of shock at the third day, is presented. The clinical picture was preceded by skin rash which became a pyoderma, and ended up as desquamation; there were several alterations: hepatic, renal, hematological (disseminated intravascular coagulation) and digestive (gastroenteritis); and Staphylococcus aureus (coagulase positive) was isolated from the skin, lochia, coproculture; and they were negative to this microorganism the ones from blood, urine and pharynx. The patient received general care for her shock, steroids, blood and fresh plasma and antimicrobial agents (dicloxacillin, cefoperazone and netilmicin). Evolution was favourable, and was discharged at the eleventh day of puerperium in good conditions. A brief summary of the bibliography about this condition, and its very low incidence in our country, is pointed out, as this report is the second one in Latin American literature.

Topics: Adult; Cefoperazone; Cesarean Section; Dicloxacillin; Female; Humans; Infant, Newborn; Netilmicin; Puerperal Infection; Shock, Septic; Staphylococcal Infections

Among 31 strains of coagulase-negative staphylococcus (CNS) causing endocarditis in individual patients, 16 had MIC of teicoplanin greater than or equal to 8 mg/l (MIC50, 8; MIC90, 8; MIC range, 0.5-32 mg/l); and 24 had MBC greater than or equal to 16 mg/l (MBC50, 32; MBC90, 64; MBC range, 4-128 mg/l). Greater sensitivity was shown to vancomycin (MIC50, 2; MIC90, 4; MIC range, 1-8 mg/l; MBC50, 2; MBC90, 4; MBC range, 0.5-8 mg/l). Teicoplanin-resistant CNS (MIC, greater than or equal to 8 mg/l) were detected in the anterior nares of two of three patients and six of nine staff, and in the air, of a cardiac surgery unit, and in other series of CNS of clinical origin. The results of in-vitro sensitivity testing of CNS to teicoplanin are dependent on the media and conditions used, and their clinical significance has not been determined. Nevertheless, the findings reported here put in question the use of teicoplanin alone as prophylaxis during valve replacement surgery.

Topics: Cardiac Surgical Procedures; Coagulase; Coronary Care Units; Drug Resistance, Microbial; Endocarditis, Bacterial; Glycopeptides; Humans; In Vitro Techniques; Netilmicin; Personnel, Hospital; Staphylococcal Infections; Staphylococcus; Staphylococcus epidermidis; Teicoplanin; Vancomycin

The bactericidal activity of two regimens of netilmicin (8 mg/kg/day) given intravenously once a day (od) or thrice daily (tid) both alone and in combination with oxacillin (200 mg/kg/day) was compared using a model of fibrin clots infected with a strain of Staphylococcus aureus (10(7) CFU/g) sensitive to methicillin and netilmicin (clinical isolate) and implanted subcutaneously in rabbit. This study shows that: 1) Netilmicin given alone as both single and divided doses results in early bacterial killing but does not exert a bactericidal effect after 24 hours because of a significant late increase of the number of bacterial. 2) The netilmicin-oxacillin combinations are more bactericidal at 1 h, 2 h and 24 h than oxacillin alone (P less than 0.001). 3) The oxacillin-netilmicin combination appears to be better for bacterial killing when netilmicin is given thrice daily (P less than 0.001). It is hard to draw a clinical inference from such an experimental study but it seems that 8-hour divided doses intervals should be better for administration of netilmicin than single daily dose during the acute period of staphylococcal infections.

Topics: Animals; Drug Administration Schedule; Drug Therapy, Combination; Fibrin; Infusions, Intravenous; Injections, Intravenous; Netilmicin; Oxacillin; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Time Factors

The Minimal Inhibitory Concentration (MIC) and Minimal Bactericidal Concentration (MBC) of 31 strains of Staphylococcus aureus resistant to methicillin and gentamicin were determined towards aminoglycosides: netilmicin (N) and amikacin (A). The results of the study showed a large discordance between the technic using dilution in Mueller-Hinton broth and the technic using agar diffusion with antibiotic discs. The level of sensitivity appears to decrease by dilution. The problem of using these aminoglycosides in combination with other antibiotics as fosfomycin (F) and pefloxacin (P) was faced. In vitro, antibacterial activity of combinations [N-F], [N-P] and [A-F], [A-P], was studied by microtiter checkerboard method. The antibacterial effects of these combinations were evaluated by determination of Fractional Bactericidal Indices (FBC-indices). The combination netilmicin or amikacin with pefloxacin has an additive bactericidal effect in most cases, without discrimination between the different aminoglycosides (FBC #0.82). Netilmicin or amikacin in combination with fosfomycin are found to be additive or moderately synergistic (FBC #0.53). No occurrence of antagonism was observed.

Topics: Amikacin; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Fosfomycin; Humans; In Vitro Techniques; Methicillin; Microbial Sensitivity Tests; Netilmicin; Pefloxacin; Staphylococcal Infections; Staphylococcus aureus

We investigated the diffusion of penicillin-G, cloxacillin, clindamycin, and netilmicin into synovial fluid and membrane in rabbits. Purulent arthritis was induced in the right knee of each rabbit by inoculation of Staphylococcus aureus phage type 3C, whereas sterile saline was injected into the left knee to serve as a control. Two days later, concentrations of antibiotics were determined in serum, synovial fluid, and membrane after an intramuscular single dose. All four drugs diffused readily into infected joints, whereas the corresponding concentrations in the normal joints were 2-3 times lower. Clindamycin showed the highest intraarticular penetration, cloxacillin the lowest. The lower penetration of cloxacillin corresponded to its higher protein binding in rabbit serum. Considering the sufficient local concentrations achieved, parenteral treatment obviates the need for local instillation of these antibiotics.

Topics: Animals; Anti-Bacterial Agents; Arthritis, Infectious; Clindamycin; Cloxacillin; Injections, Intra-Articular; Injections, Intramuscular; Knee Joint; Netilmicin; Penicillins; Rabbits; Staphylococcal Infections; Synovial Fluid; Synovial Membrane

In ventriculitis caused by Gentamicin-resistant staphylococcus aureus and staphylococcus epidermidis, Netilmicin was administered intrathecally to 19 patients under continuous control of the Netilmicin concentration in cerebro-spinal fluid (CSF). This therapy was able to bring these otherwise lethal infections under control, usually within 10 days. Pharmacokinetic studies with different doses have shown that doses of 2 X 3 mg are to be recommended in moderately severe cases of ventriculitis, and in most severe infections 3 X 3 mg daily intraventricularly for adults. In infants daily intraventricular injections of 2 X 0.4-0.5 mg Netilmicin are a sufficient dose to produce an effective antibiotic concentration level.

Topics: Adolescent; Adult; Aged; Catheterization; Cerebral Ventricles; Child, Preschool; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Encephalitis; Female; Gentamicins; Humans; Infant; Injections, Intraventricular; Injections, Spinal; Male; Middle Aged; Netilmicin; Staphylococcal Infections

The authors evaluated the susceptibility of some antibiotics against several Staphylococci subdivided in lyogroups and different resistance patterns: methicillin-susceptible/penicillin-susceptible (MS/PS), methicillin-susceptible/penicillin-resistant (MS/PR), methicillin-resistant/penicillin-resistant (MR/PR) and methicillin-resistant/penicillin-susceptible (MR/PS). The antimicrobial agents used were: methicillin, penicillin, rifampin, tetracycline, lincomycin, erythromycin, gentamicin and netilmicin. Netilmicin showed better activity against all Staphylococcus strains tested, particularly against coagulase-negative.

Topics: Anti-Bacterial Agents; Erythromycin; Gentamicins; Humans; Lincomycin; Methicillin; Microbial Sensitivity Tests; Netilmicin; Penicillin Resistance; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Tetracycline

Topics: Adolescent; Adult; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Rifampin; Staphylococcal Infections; Staphylococcus

Topics: Aged; Cephalothin; Child; Drug Antagonism; Endocarditis, Bacterial; Floxacillin; Fusidic Acid; Gentamicins; Humans; Male; Netilmicin; Staphylococcal Infections; Streptococcal Infections

Two in vitro beta-lactam antibiotic (oxacillin, cefotaxime) 'tolerant' (MBC:MIC ratios = greater than 32) strains of Staphylococcus aureus served to intraperitoneally infect cyclophosphamide-pretreated (leukopenic) NMRI mice. With larger bacterial inocula (approximately 5 X 10(8) CFU) neither oxacillin nor gentamicin or netilmicin yielded optimal chemotherapeutic results. Only combination chemotherapy, in particular oxacillin combined with netilmicin, consistently reduced mouse mortality significantly (p less than 0.001). In contrast, moderate 'tolerant' staphylococcal inocula (approximately 2 X 10(8) CFU) were amenable to chemotherapy with either oxacillin or netilmicin, but not with cefotaxime or gentamicin. Oxacillin combined with either gentamicin or netilmicin resulted in significantly lowered murine mortality rates (p less than 0.001). Cefotaxime combined with either aminoglycoside antibiotic gave less satisfactory results. Systemic murine infections due to three non-'tolerant' strains of S. aureus were amenable to chemotherapy with oxacillin, cefotaxime or netilmicin alone and to combination chemotherapy. It is recommended that cases of life-threatening S. aureus infection, not complicated by acute endocarditis, initially be treated with oxacillin plus netilmicin until availability of laboratory results (antibiogram, documentation of 'tolerance').

Topics: Animals; Cefotaxime; Cyclophosphamide; Drug Tolerance; Gentamicins; Mice; Netilmicin; Oxacillin; Staphylococcal Infections

Clinical aspects of Continuous Ambulatory Peritoneal Dialysis (CAPD) were studied in the first fifty patients started on CAPD at our hospital. CAPD was found to achieve good control of the uremic symptoms and of the biochemical values studied. Hypertension became less pronounced. The costs were found to be low. Twenty-four diabetic subjects were studied in detail. Intraperitoneal administration of insulin resulted in good metabolic control of the diabetes. The two catheters used for peritoneal access were compared. Because of problems related to the removal of the Toronto Western Hospital catheter it was concluded that the Tenckhoff catheter was to be preferred. Peritonitis was found to be the worst complication. Coagulase negative staphylococci accounted for 57% of the cases. During the study an increasing percentage of infections were caused by bacteria with multiple resistance to antibiotics. Netilmicin, a new aminoglycoside, was evaluated for the treatment of CAPD-related peritonitis. 84% of the cases responded. One of the nineteen patients treated sustained reversible vestibular toxicity. No other side effects were noted. In two patients right-sided hydrothorax was found to be a complication of peritoneal dialysis. In one case it was demonstrated that defects in the right diaphragm was the cause of the complication. In the other CAPD was continued despite the complication.

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Diabetic Nephropathies; Humans; Hydrothorax; Netilmicin; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Staphylococcal Infections; Sweden; Time Factors; Uremia

Bacterial endophthalmitis is difficult to treat because antibiotics administered systemically, subconjuctivally or topically cannot be delivered in bactericidal amounts to the infected tissues. Netilmicin, a new aminoglycoside, is active against Pseudomonas aeruginosa, Staphylococcus and most Enterobacteriaceae, including Escherichia coll, Klebsiella and Enterobacter, that have been resistant to other aminoglycosides. In rabbits an intravitreal injection of 250 mu g/0.1 ml rapidly provided a bactericidal concentration (greater than 10 mu g/ml) in the vitreous, and this level was maintained for 100 hours. This dose was not toxic to ocular tissues, unlike higher doses (1000 to 2000 mu g). Intravenous, subconjunctival and topical administration yielded only low concentrations of the drug in the vitreous, although subconjunctival injection yield significant concentrations in the aqueous for 4 hours. Experimentally induced Staphylococcus aureus endophthalmitis was quickly eradicated by a single intravitreal dose of netilmicin without detectable sequelae in 9 to 10 eyes studied. A solution of netilmicin infused during vitrectomy and lensectomy prevented infection.

Topics: Administration, Topical; Animals; Aqueous Humor; Conjunctiva; Endophthalmitis; Gentamicins; Injections; Injections, Intravenous; Netilmicin; Rabbits; Staphylococcal Infections; Vitreous Body

30 urological patients with normal renal function were treated with netilmicin because of urinary tract infections, mostly recurrent and due to predisposing factors. the drug was given in doses of 4 mg/kg/day for 4-9 days. All but 5 patients had resolution of their signs and symptoms, and the bacteria were eliminated in 23 patients, with recurrence in 8 and reinfection in 3. The bacteria persisted in 1 patient and the results were indeterminate in 6 patients. No signs of hematopoietic, renal and hepatic toxicity occurred, and vestibular and auditory functions were undisturbed. Regular assays of serum drug concentrations revealed no signs of accumulation. Netilmicin given in doses of 4 mg/kg/day is an efficient antibiotic with low toxicity in the treatment of urinary tract infections.

Topics: Adolescent; Adult; Aged; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections

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

The efficacy and toxicity of netilmicin was assessed in 15 patients with life-threatening infections, including six with septicaemia. Fourteen patients were cured with no recurrence of infection. The initial dosage of netilmicin was 200 mg twice a day (2.3-4.0 mg/kg/dose), but subsequent adjustment of dosage was made according to the results of serum assay, either to avoid accumulation or to improve therapeutic response. Probable nephrotoxicity occurred in only one patient and there was no evidence of ototoxicity in the twelve patients who could be assessed.

Topics: Adult; Aged; Bacterial Infections; Creatinine; Drug Evaluation; Enterobacteriaceae Infections; Female; Gentamicins; Hearing; Humans; Kidney; Male; Middle Aged; Netilmicin; Pseudomonas Infections; Staphylococcal Infections

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

The efficacy and toxicity of netilmicin, a new semisynthetic aminoglycoside, was clinically evaluated in fifty-two patients with moderate to severe infections with Gram-negative rods or Staph. aureus. Average duration of treatment was 14 days and mean total dose 2,960 mg. One-hour mean value of netilmicin serum concentration was 6.4 microgram/ml and mean trough value 1.2 microgram/ml. Forty-four patients were cured or improved. In twenty-one of them the effect could be attributed to netilmicin alone; the other twenty-three had a combined therapy. No improvement took place in five, but four of them could not be regarded as netilmicin failure. One patient with Pseudomonas aeruginosa infection was possible failure. The sensitivity of the causative bacteria to netilmicin was studied and compared with amikacin, gentamicin, sisomicin and tobramycin. Vestibular function and hearing acuity was thoroughly examined by electronystagmography and audiography. Drug-related VIIIth nerve damage could not be confirmed in any of our patients. Five patients showed a rise of serum creatinine of 30 mumol/l. This shows that netilmicin, similar to other aminoglycosides, is a potential nephrotoxic drug. Netilmicin appears to be an efficacious aminoglycoside and the oto- and nephrotoxicity is low, if careful attention is paid to the renal function and the serum concentrations of the drug.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Child; Female; Gentamicins; Hearing; Humans; Kidney; Male; Middle Aged; Netilmicin; Staphylococcal Infections; Staphylococcus; Vestibular Nerve