netilmicin and Urinary-Tract-Infections

The authors had for aim to assess the effectiveness and toxicity of a piperacillin-tazobactam-netilmicin combination, and the possibility of avoiding using glycopeptide, in children with febrile neutropenic episodes induced by chemotherapy.. A retrospective study was made, including children treated for a febrile neutropenic episode (absolute neutrophile count < 0.5 x 10(9)/l) by a piperacillin-tazobactam-netilmicin combination. If fever persisted 48 hours after the beginning of antibiotic therapy, a glycopeptide could be added. The responses to the treatment were defined as follows: 1) total success (no fever or documented infection) at 48 hours and at 72 hours following the beginning of treatment; 2) partial success (apyrexia beyond 72 hours without any therapeutic change); 3) failure (persistent infectious signs 48 hours after the introduction of glycopeptide).. Sixty-nine episodes were assessable, corresponding to 41 patients, treated for a solid tumour (29), an acute leukaemia in remission (11), or a metabolic disease (1). The febrile episodes were divided into fever of unknown origin (71%), microbiologically documented fever (12%), and clinically documented fever (17%). No death occurred, no toxicity was reported. With this antibiotic therapy, total success at 72 hours was observed in 72% in case of fever of unknown origin and 45% in case of documented infections. The success rate reached 84% when a glycopeptide was added (30% of the cases).. The piperacillin-tazobactam-netilmicin combination is very effective and well tolerated in probabilistic treatment of febrile neutropenia induced by chemotherapy, but does not allow to decreasing the frequency of glycopeptide administration.

Topics: Adolescent; Anti-Bacterial Agents; Antineoplastic Agents; Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Escherichia coli Infections; Female; Fever; Fever of Unknown Origin; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Infant; Male; Neoplasms; Netilmicin; Neutropenia; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies; Treatment Outcome; Urinary 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

A randomized comparative open clinical trial was performed on 96 hospitalized patients of both sexes, most of whom (84.4%) over 60 years of age, affected by simple and complicated urinary tract infections. Patients were divided in three unequal sized groups and treated with a single administration of netilmicin (5 mg/kg intramuscularly), of amikacin (15 mg/kg i.m.) or of fosfomycin (3 g per os). Patients were evaluated clinically and microbiologically before the beginning of the therapy, 1, 7, 15, 30 days thereafter and at monthly intervals, up to the 18th month, after the drug administration. The pharmacokinetic study was performed in six elderly patients of both sexes, apparently in good general health, except for their urinary tract infections. Symptoms of urinary tract infection disappeared in 50 out of 53 (94.3%) patients treated with netilmicin 14.48 +/- 9.6 hours after the drug administration, in 22 out of 23 (95.6%) of those treated with amikacin after 31.9 +/- 14.3 hours and in 16 (84.2%) out of 19 of symptomatic patients treated with fosfomycin after 37.5 +/- 10.6 hours. The disappearance of symptoms in netilmicin-treated patients is significantly (p less than 0.01) faster than in the other two groups. Twenty-four hours after the administration, netilmicin and amikacin produced sterilization of the cultures in more than 95% of cases, fosfomycin in 90%. Of those patients in which sterilization of cultures was achieved about 70%, in the netilmicin group, and 50% in the other two treatment groups had sterile urine cultures after one month. At the end of the study, 18 months later, more than 60% of the patients treated with netilmicin, the infection had not recurred in comparison with 39.1% and 50% in the amikacin and fosfomycin groups respectively. If only the patients with uncomplicated infections were considered, 88.9% and 83.3% had sterile cultures after 1 and 18 months respectively in the netilmicin group. The corresponding figures in other two groups were: 66.7% for both time intervals in the case of amikacin and 60% both for 1 and 18 months in the case of fosfomycin. The pharmacokinetic results indicate that netilmicin is rapidly absorbed and distributed from the injection site, possesses a beta half-life of about two hours and is mainly excreted by the kidneys. The single dose administration produces very high urinary concentrations of the drug in the first 24 hours and concentrations above 4 micrograms/ml, the 90% minimum inhibitory concent

Topics: Age Factors; Aged; Algorithms; Amikacin; Female; Fosfomycin; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Urinary Tract Infections; Urine

An open randomized study was done to compare the prophylactic value of single doses of netilmycin-metronidazole versus trimethoprim-sulfamethoxazole in the prevention of postoperative infections associated with transrectal prostatic biopsy. Of 117 patients enrolled in the study 101 were evaluated and of these patients 47 received netilmycin-metronidazole and 54 received trimethoprim-sulfamethoxazole. The bacteremia rate in the netilmycin-metronidazole group was 28% (13 of 47 patients) with a 95% confidence interval of 18 to 42% and in the trimethoprim-sulfamethoxazole group it was 37% (20 of 54) with a confidence interval of 26 to 50% (p = 0.43). None of the patients with bacteremia was symptomatic. Urinary tract infection rates were greater in the netilmycin-metronidazole group: 17% (8 of 47 patients) versus 2% (1 of 54) in the trimethoprim-sulfamethoxazole group, p = 0.01. Trimethoprim-sulfamethoxazole (cotrimoxazole) is a better choice as an antimicrobial prophylaxis for patients undergoing transrectal prostatic biopsy.

Topics: Aged; Aged, 80 and over; Biopsy; Drug Combinations; Humans; Infection Control; Infections; Male; Metronidazole; Middle Aged; Netilmicin; Premedication; Prostate; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The pharmacologic parameters and toxicity of netilmicin (6 mg/kg/day) given once daily (qd) or thrice daily (tid) for the treatment of urinary tract infections were studied in a randomized prospective study of 60 cancer patients. The overall efficacy was 96%. Nephrotoxicity, assessed by the measure of urinary excretion of phospholipids, was lower for the patients receiving the qd regimen than for those receiving the tid regimen. Elevation of serum creatinine (20% over baseline) occurred in one patient receiving the qd regimen and in three receiving the tid regimen. Cochleotoxicity, assessed by pure-tone audiometry (250 to 18,000 Hz) occurred in one patient receiving the qd regimen and none receiving the tid regimen. Concentrations in sera were measured on days 1 and 5. No significant accumulation was observed in either group. Median serum bactericidal titers, expressed as reciprocal values (percentage of the sera with a titer greater than or equal to 8), were measured against 25 test organisms in samples collected 6 h after the administration of netilmicin and were, for the qd group, 16 (82%) against members of the family Enterobacteriaceae and less than 2 (8%) against Pseudomonas aeruginosa, and for the tid group, 4 (57%) against members of the Enterobacteriaceae and less than 2 (0%) against P. aeruginosa. The rate of killing in serum was rapid (2 to 3 log in 2 h against P. aeruginosa; 3 to 5 log in 2 h against members of the Enterobacteriaceae) and correlated with the sampling time and hence the concentration in serum of netilmicin. The duration of the postantibiotic effect in serum depended also on the strain and the sampling time of the serum.

Topics: Adult; Aged; Aged, 80 and over; Bacteria; Blood Bactericidal Activity; Cochlea; Female; Hearing Disorders; Humans; Kidney Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasms; Netilmicin; Urinary Tract Infections

Fosfomycin trometamol (FT), an antibiotic active against the common urinary pathogens, may be demonstrated in adequate urine concentrations up to 36-48 h after a single oral dose of 1-2 g. This pharmacokinetic peculiarity seems to indicate that this antibiotic may be used in single doses in the therapy of lower urinary tract infections (UTIs) in infants and children. The efficacy and safety of FT in single oral doses was compared with those of netilmicin (NM), an aminoglycoside antibiotic with a demonstrated efficacy in bolus doses against UTIs, shown in a multicentric study. One hundred and thirty-five children with lower UTI, diagnosed on the basis of fever (less than 38 degrees C), erythrocyte sedimentation rate (less than 25 mm/l h) and C-reactive protein (less than 20 micrograms/ml), were included in the study: 71 received 2 g of FT, 64 5 mg/kg of NM. Cure, defined as persistence of sterile urine up to 30 days after therapy, was reached in 80.2% of children in the FT group and in 81.2% of children in the NM group. Persistence of infection was demonstrated in 7 and in 3 children, respectively. Recurrence of infection was noticed in 7 patients in the FT group and in 9 in the NM group. No differences between FT- and NM-treated children are demonstrable even if the patient population is analyzed according to the higher risk of UTI because of the presence of an anatomical and/or functional abnormality of the urinary tract or due to a previous tendency to recurrent UTIs. FT is as effective as NM in the treatment of lower UTIs in infants and children.

Topics: Adolescent; Child; Child, Preschool; Female; Fosfomycin; Humans; Infant; Infant, Newborn; Male; Netilmicin; Remission Induction; Urinary Tract Infections

To evaluate the efficacy of preoperative antibiotic prophylaxis, we studied 130 patients who were submitted to prostate surgery. These patients were divided into 3 groups. Overall morbidity was lower for the patient group that had received antibiotic prophylaxis (Netilmicin, 3 doses) than for the group on placebo and the group on antibiotics postoperatively. The incidence of significant bacteriuria for the group on Netilmicin was less at 7 days (7.5%) and at 30 days (20.5%) than for the other groups: (22.55%) and (49.36%) at 7 and 30 days, respectively. The foregoing data indicate that preoperative antibiotic prophylaxis should be used for periods less than 24 h in all noninfected patients undergoing prostate surgery. The cost of antibiotic therapy, presence of opportunistic organisms and the duration of hospital stay are reduced by antimicrobial prophylaxis.

Topics: Humans; Male; Netilmicin; Postoperative Complications; Premedication; Prostatic Diseases; Urinary Tract Infections

The aim of the study was the evaluation of the clinical efficacy and the kidney tolerance of ceftazidime in comparison with netilmicin in pediatric patients. Forty subjects, ranging from six months to ten years of age were randomly allocated in two groups and treated either with ceftazidime (80-100 mg/kg/day) or netilmicin (6 mg/kg/day). A control group of twenty subjects was selected in order to establish the normal values of beta 2-microglobulin and urinary enzymes excretion. beta 2-microglobulin, enzymuria, cylindruria and urinary osmolability were estimated, as well as hematological parameters. Ceftazidime was as efficacious as netilmicin in the clinical outcome and in addition it did not cause any pathological change in early markers of tubular damage.

Topics: beta 2-Microglobulin; Ceftazidime; Child; Child, Preschool; Humans; Infant; Kidney Diseases; Liver Function Tests; Netilmicin; Urinary Tract Infections

Topics: Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Escherichia coli Infections; Female; Fosfomycin; Humans; Infant; Male; Netilmicin; Random Allocation; Urinary Tract Infections

Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).

Topics: Humans; Male; Netilmicin; Postoperative Complications; Premedication; Prostatectomy; Random Allocation; Urinary Tract Infections

A randomised trial was undertaken to compare the efficacy of netilmicin and ceftriaxone for the treatment of severe or complicated urinary tract infections. Forty-seven patients completed the study. Twenty-three of 24 patients treated with netilmicin and 21 of 23 treated with ceftriaxone were cured. One patient treated with netilmicin had a mild, reversible disturbance of renal function. Six patients developed diarrhoea after ceftriaxone treatment.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Netilmicin; Prospective Studies; Random Allocation; Urinary Tract Infections

Fifty-nine patients with severe urinary tract infections were treated with either cefotaxime or ampicillin plus netilmicin in a controlled, open randomised study of the clinical and bacteriological effects. The patients responded favourably in both groups. The minimum inhibitory concentrations of cefotaxime against the isolates from blood were low for all bacterial strains except one (Streptococcus faecalis). Time to normalisation of temperature was significantly shorter in the cefotaxime group. The results suggest that cefotaxime is an effective and well-tolerated agent in the treatment of serious infections. However, the difference between the two groups was too small to allow preference of one procedure over the other.

Topics: Ampicillin; Cefotaxime; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Netilmicin; Sepsis; Surgical Wound Infection; Urinary Tract Infections

Forty-one patients with urinary tract infections were randomly assigned to receive for six days gentamicin, amikacin, sisomicin or netilmicin. The dose for each patient was calculated according to creatinine clearance and lean body mass in order to avoid overdosages. Urinary enzymes (alpha-glucosidase, gamma-glutamyltranspeptidase and muramidase), serum creatinine and creatinine clearance, proteinuria and urinary sediment were evaluated for nephrotoxicity. None of the patients developed nephrotoxicity, but urinary enzymes rose significantly in all. The statistical analysis of enzymuria during the treatment permitted the definition of a rank order of the nephrotoxic potential of the aminoglycosides studied.

Topics: Adolescent; Adult; Aged; alpha-Glucosidases; Amikacin; Creatinine; Female; gamma-Glutamyltransferase; Gentamicins; Glucosidases; Humans; Kanamycin; Kidney; Male; Middle Aged; Muramidase; Netilmicin; Proteinuria; Sisomicin; Urinary Tract Infections

A randomised trial was undertaken to compare the efficacy and safety of netilmicin and cefoperazone for the treatment of severe or complicated urinary tract infections. Thirty-two patients completed the study. Fifteen of 16 patients treated with netilmicin and nine of 16 treated with cefoperazone were cured. This difference was statistically significant (p = 0.037). No serious side effects or toxicity occurred with either drug, although five patients developed diarrhea after treatment with cefoperazone.

Topics: Acute Disease; Adolescent; Adult; Aged; Cefoperazone; Clinical Trials as Topic; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Pyelonephritis; Random Allocation; Urinary Tract Infections

An open clinical trial was carried out to evaluate therapeutic efficacy and safety of netilmicin. Forty hospitalized adult patients suffering from complicated urinary tract infections (UTI) (19), lower respiratory tract infections (20), septicemia (3) and soft tissue infection (1) due to in vitro susceptible microorganisms were admitted to the study. Twenty-nine of these patients had severe underlying diseases interfering with host defenses. Twenty-nine out of the 40 patients (73%) were cured and 6 (15%) had a favorable clinical response giving an overall satisfactory clinical response of 88%. Eradication of causative microorganisms was obtained in 29 (73%) patients, and three substitutions during or at the end of treatment were observed. Netilmicin was well tolerated: neither clinical abnormalities of otovestibular function nor hepatic or hematological alterations were found, while only two patients developed a mild and transient increase of BUN and creatinine serum levels.

Topics: Adult; Aged; Bronchopneumonia; Clinical Trials as Topic; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Urinary Tract Infections

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 (age 3 months to 10 years) with complicated and uncomplicated lower urinary tract infections were treated with a single intramuscular injection of netilmicin 4.5 mg/kg. The diagnosis of lower urinary tract infection was based on the absence of fever and the presence of normal values for erythrocyte sedimentation rate, C-reactive protein concentration and urinary excretion of N-acetyl-beta-D-glucosaminidase. Follow-up urine cultures in all children demonstrated a cure rate of 97% and reinfection and relapse rates each of 7% respectively. The subgroup (12 children) with radiological abnormalities of urinary tract showed a cure rate of 92%, and reinfection and relapse rates of 9% respectively. The rates of cure, reinfection and relapse in the complicated and uncomplicated urinary tract infections were not statistically different (p greater than 0.05). A pharmacokinetic study (performed in 5 children) demonstrated that netilmicin urinary concentrations were over the MIC's of the infecting organisms up to 96 hours after the single-dose injection. Netilmicin was well tolerated and no side effects appeared during treatment. Single-dose netilmicin therapy is an effective and safe regimen for complicated and uncomplicated urinary tract infections in children. The response to single-dose netilmicin therapy seems to be related to its prolonged urinary elimination.

Topics: Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Female; Gentamicins; Humans; Infant; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Netilmicin; Urinary Tract Infections

We studied for one year 60 patients separated in 3 groups of 20: first reference group without treatment; second group receiving netilmicin in premedication; third group treated by netilmicin for 2 days postoperatively. This series clearly demonstrates the high urinary tract infection rate after transurethral surgery, the benefit of antibioprophylaxis with netilmicin and the efficiency of one dose of this aminosid given one hour preoperatively.

Topics: Aged; Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Netilmicin; Polyps; Postoperative Complications; Prostatectomy; Urethra; Urinary Bladder Neoplasms; Urinary Tract; Urinary Tract Infections

Topics: Adult; Aged; Clinical Trials as Topic; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Recurrence; Urinary Tract Infections

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

Topics: Bacterial Infections; Clinical Trials as Topic; Diarrhea, Infantile; Female; Follow-Up Studies; Gentamicins; Humans; Infant, Newborn; Male; Netilmicin; Pneumonia; Sepsis; 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

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

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

The efficacy and tolerance of netilmicin was studied in 28 elderly male patients with varying degrees of renal function impairment who suffered from complicated urinary tract infections. Doses of netilmicin, equivalent to 2 mg/kg divided by milligrams of creatinine per 100 ml, were administered every 12 h. A 62% cure rate, defined as negative urine culture at 1-week follow-up, was obtained. Treatment failure correlated with impaired renal function. Nephrotoxic reaction, defined as any significant increase in serum creatinine during treatment, was found in 6 of 28 patients (21%). The increase in serum creatinine was transient in all except one of these patients. Apart from the finding of a significant correlation between nephrotoxic reaction to netilmicin and postoperative urinary tract infection, no clinical or therapeutic features correlated with nephrotoxicity; trough concentrations correlated with serum creatinine.

Topics: Aged; Blood Urea Nitrogen; Clinical Trials as Topic; Creatinine; Gentamicins; Humans; Kidney Diseases; Male; Middle Aged; Netilmicin; Time Factors; Urinary Tract Infections

Netilmicin and amikacin, two recently developed aminoglycosides, were compared in a prospective, randomized study of 57 male patients with complicated urinary tract infections. Both drugs were administered intramuscularly every 12 h for 7 to 10 days, netilmicin at 2 mg/kg and amikacin at 7.5 mg/kg. The two groups were comparable as to infecting bacteria and underlying pathology of the urinary tract. No patients had indwelling catheters. All microorganisms isolated were sensitive to both antibiotics. A total of 69% of the patients treated with netilmicin and 57% of the patients treated with amikacin were cured of the infection, as defined by a negative culture at 7 days after discontinuation of treatment. No major side effects were recorded, and no significant changes were noted in parameters of renal function. Of the patients treated with amikacin, 21% experienced temporary local pain at the injection site; no such effect was noted in the netilmicin-treated group. Therefore, netilmicin appeared to be as effective and better tolerated than did amikacin in the treatment of complicated urinary tract infection.

Topics: Adult; Aged; Amikacin; Clinical Trials as Topic; Gentamicins; Humans; Kanamycin; Kidney; Male; Middle Aged; Netilmicin; Urinary Tract Infections

Escherchia coli isolated, from urine samples were studied for their antibiotic susceptibility patterns, with special reference to the new antimicrobial compound fosfomycin and their correlation with various virulence factors.. The mid stream urine samples received in the department were processed and identification was done by using the standard culture and identification techniques. The antibiotic susceptibility testing was done by modified Kirby-Bauer disk diffusion and the disk diffusion method was used to confirm the ESBL, AmpC, MBL production by the UPEC. Various virulence factors like hemolysin, haemagglutinaton, gelatinase, siderophore production, biofilm formation, serum resistance and hydrophobicity were detected.. Fosfomycin was found to be most effective agent (100%) against uropathogenic E.coli followed by netilmicin (89.5%). The least effective agents were ampiciilin and cotrimoxazole. Twenty nine percent (29%) isolates were found to be multi drug resistant (MDR).. The testing of the newer therapeutic agents like fosfomycin will add on to therapeutics for UTI's.

Topics: Ampicillin; Anti-Bacterial Agents; Biofilms; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Fosfomycin; Humans; Microbial Sensitivity Tests; Netilmicin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Uropathogenic Escherichia coli; Virulence Factors

Escherichia coli is considered as the most common cause of urinary tract infection (UTI) and acquired multiple resistances to a wide range of antibiotics such as aminoglycosides. Enzymatic alteration of aminoglycosides (AMEs) by aminoglycoside- modifying enzymes is the main mechanism of resistance to these antibiotics in E. coli. The aim of this study was detection and investigation of frequency of genes encoding aminoglycoside modifying enzymes (aac(3)-IIa and ant(2'')-Ia) in UPEC isolated from hospitalized patients in teaching hospital of Tehran, Iran.. A total of 276 UPEC were obtained from Urine samples in a hospital from Tehran. Antibiotic susceptibility to aminoglycosides was determined by disk diffusion method according CLSI guidelines in UPEC isolates. MICs of target antibiotics were determined by agar dilution method. All isolates were screened for the presence of the AMEs genes using the PCR. The results of disk diffusion showed 21%, 24.6%, 23.18%, 3.62% and 6.15% of isolates were resistant to Gentamicin, Tobramycin, Kanamicin, Amikacin and Netilmicin respectively. The agar dilution's results (MICs) were high, 66.19% for Gentamicin. The aac (3)-IIa and ant(2″)-Ia genes were detected in (78.87%) and 47.88% of isolates respectively.. This study shows the high frequency of genes encoding (AMEs) aac(3)-IIa and ant(2")-Ia genes and their relationship between different aminoglycoside resistance phenotypes.

Topics: Amikacin; Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Escherichia coli Infections; Gene Expression Regulation, Bacterial; Gene Frequency; Genes, Bacterial; Gentamicins; Hospitals, Teaching; Humans; Iran; Kanamycin; Netilmicin; Tobramycin; Urinary Tract Infections; Uropathogenic Escherichia coli

Vertilmicin is a novel aminoglycoside antibiotic with potent activity against gram-negative and -positive bacteria in vitro. In this study, we further evaluated the efficacy of vertilmicin in vivo in systemic and local infection animal models. We demonstrated that vertilmicin had relatively high and broad-spectrum activities against mouse systemic infections caused by Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. The 50% effective doses of subcutaneously administered vertilmicin were 0.63 to 0.82 mg/kg, 0.18 to 0.29 mg/kg, 0.25 to 0.99 mg/kg, and 4.35 to 7.11 mg/kg against E. coli, K. pneumoniae, S. aureus, and E. faecalis infections, respectively. The therapeutic efficacy of vertilmicin was generally similar to that of netimicin, better than that of gentamicin in all the isolates tested, and better than that of verdamicin against E. coli 9612 and E. faecalis HH22 infections. The therapeutic efficacy of vertilmicin was further confirmed in local infection models of rabbit skin burn infection and mouse ascending urinary tract infection.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Burns; Enterococcus faecalis; Escherichia coli; Female; Klebsiella pneumoniae; Male; Mice; Microbial Sensitivity Tests; Netilmicin; Rabbits; Skin Diseases; Staphylococcus aureus; Urinary Tract Infections

The prevalence of antimicrobial resistance among uropathogenic E. coli varies widely worldwide; to guide empirical therapy is necessary to have local, up-to-date susceptibility data.. We tested 907 isolates from patients in Mexico City by disk diffusion and further characterized ciprofloxacin, cephalosporin and nitrofurantoin resistant strains.. Isolates were mostly resistant to ampicillin (74%), trimethoprim-sulfamethoxazole (60.1%) and ciprofloxacin (32.6%). The most effective drug was netilmicin (5.1% resistant) and the most effective of oral drugs was nitrofurantoin (7.4% resistant). Sixty-percent of ciprofloxacin-resistant strains had minimal inhibitory concentrations of 125 microg/ml or higher, well beyond urinary concentrations at the end of the 12-hour inter-dose period for standard oral regimes. Extended-spectrum beta-lactamases were detected in 6% of strains, most of them from community-acquired infections. All strains resistant to nitrofurantoin carried a 20 Kb plasmid, which when transformed into a susceptible recipient, conferred resistance to nitrofurantoin, ampicillin, sulfonamides, streptomycin, and partially protected against ciprofloxacin.. Drugs considered of choice against uncomplicated urinary tract infections are facing high resistance prevalences and resistance determinants formerly seen only at hospitals are now among community strains. Treatment guidelines from developed countries might not reflect these local trends.

Topics: Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Humans; Mexico; Microbial Sensitivity Tests; Netilmicin; Nitrofurantoin; Pregnancy; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli

A feverish high temperature is the symptom that most frequently leads families to take their children to a Pediatric First Aid unit. In the differential diagnosis of the causes of hyperpyrexia the presence of infections of the genito-urinary tract have to be excluded. Infections of the urinary ways are often the cause of high temperatures in infancy, particularly during the 1st year of life; early identification at the moment of examination at the Paediatric First Aid clinic of patients with infections of the urinary ways makes it possible to prevent the onset of renal complications. We carried out a retrospective study with the purpose of evaluating the incidence of infections of the urinary ways and their complications in paediatric patients who had come to the First Aid unit for hyperpirexia and were later hospitalised after examination of the urine revealed and infection of the urinary ways.. The study was carried out by consulting the registers listing arrivals at the First Aid unit and the subsequent discharge diagnosis. We then consulted the clinical records of patients who required admission to our Paediatrics Clinic arter the first aid examination.. Re-reading the registers of examination carried out and the clinica records of hospitalised patients there emerged an increase in the observation of this pathology, diagnosed at the moment of the First Aid examination by means of rapid tests and thereafter assessed by haematochemical and radiological tests.. In our opinion this increase could be attributed to the greater attention paid to diagnosing the causes of fever of apparently unknown origin.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Female; First Aid; Humans; Infant; Infant, Newborn; Italy; Male; Medical Records; Netilmicin; Retrospective Studies; Urinary Tract Infections

Imipenem (CAS 64221-86-9) as well as netilmicin (CAS 56391-57-2) at suprainhibitory concentrations induced the postantibiotic effects against three P. aeruginosa strains. Imipenem (2 x or 4 x minimal inhibitory concentration (MIC)) showed postantibiotic effects in the range of 0.3-1.6 h and 0.9-4.0 h. Netilmicin at the same concentrations produced postantibiotic effects of 3.0-3.8 h and 3.5-4.5 h. Postantibiotic effects manifested by imipenem (2 x or 4 x MIC) + netilmicin (2 x MIC) combination were somewhat longer (in the range of 4.6-4.9 h and 5.8-7.4 h) than the mathematical sum of postantibiotic effects induced by drugs alone (in the range of 4.1-4.7 h and 4.7-7.0 h).

Topics: Carbapenems; Drug Therapy, Combination; Gentamicins; Humans; Imipenem; Microbial Sensitivity Tests; Netilmicin; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections

In 26 patients with different clinical forms of infections of the urinary pathways a 300 mg single dose of netilmicin was administered by the i.m. route and the bacteriological urinary finding was checked for as long as 10 weeks after administration of netilmicin. During this period the urine was bacteriologically negative in 42% of the subjects. In 8 subjects with relapses of the infection a second dose of 300 mg netilmicin was administered and the urine was bacteriologically negative for 10 weeks in four of the patients. On the whole it proved possible to eliminate the urinary infection for 42-112 days in 17 subjects (65%), even in so-called complicated infections. It may be stated that single dose treatment with netilmicin used once or repeatedly leads to prolonged elimination of the infection without affecting the sensitivity of the organisms, without side-effects and with a substantial reduction of the cost of treatment.

Topics: Adult; Aged; Aged, 80 and over; Drug Administration Schedule; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Time Factors; Urinary Tract Infections

The authors submit the results of treatment of non-complicated urinary tract infections by a single dose of netilmicin. They treated 23 patients to whom they administered a single dose of 200 mg netilmicin by the i.m. route. A positive short-term effect was recorded in 82.8%. Cases of failure of this treatment indicate the necessity of careful indication of a single dose of netilmicin only to patients with non-complicated infections of the urinary pathways.

Topics: Adult; Aged; Aged, 80 and over; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Netilmicin; Urinary Tract Infections

Topics: Adult; Aged; Anti-Bacterial Agents; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Netilmicin; Treatment Outcome; Urinary Tract Infections

Topics: Amikacin; Female; Humans; Male; Netilmicin; Pelvic Inflammatory Disease; Phospholipids; Time Factors; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Drug Resistance, Microbial; Dysentery, Bacillary; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Staphylococcus aureus; Urinary Tract Infections

In vitro activity of Cefotaxime, Ceftriaxone, Ceftazidime, Piperacillin and Netilmicin against 189 urinary isolates of Enterobacteriaceae, Pseudomonas and Enterococcus has been evaluated. To assess the minimal inhibitory concentrations (MIC), the broth dilution method and the Sensititre system were employed. No considerable differences were found between the two methods. Cefotaxime showed the highest activity against Enterobacteriaceae, the great majority of the isolates being susceptible to 1 microgram/ml or less. Piperacillin showed good activity against Enterococci. Ceftazidime resulted the most active against Pseudomonas.

Topics: Cefotaxime; Ceftazidime; Ceftriaxone; Humans; Microbial Sensitivity Tests; Netilmicin; Piperacillin; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Drug Evaluation; Female; Humans; Kidney Diseases; Male; Middle Aged; Netilmicin; Urinary Tract Infections

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

Topics: Adolescent; Adult; Aged; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Bacterial Infections; Connective Tissue Diseases; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Osteomyelitis; Urinary Tract Infections

Topics: Adult; Aged; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Urinary Tract Infections

Following surgery for the removal of intrarenal calculi 30% of patients will develop severe wound complications. This study assesses the role of a short course of netilmicin given over the operative period, in 20 consecutive patients. Preoperative studies demonstrated that whilst 20% of patients had bacterial growth in the urine, culture of the removed calculus demonstrated that 50% of the stones exhibited a significant bacterial growth. Of the 20 patients, only one developed a wound complication. Following the preoperative dose, satisfactory netilmicin levels were obtained and no patient had levels greater than 1 microgram ml-1 by 7 h. Despite some degree of renal impairment, serum urea and creatinine values were unaffected.

Topics: Adult; Aged; Female; Gentamicins; Humans; Kidney Calculi; Male; Middle Aged; Netilmicin; Premedication; Surgical Wound Infection; Urinary Tract Infections

Netilmicin was intramuscularly injected at a daily dose of 200 mg, divided twice, for 5 to 10 days to 14 patients with complicated urinary tract infection caused by P. aeruginosa. The clinical results were excellent in 7 cases, good in 5 cases, and fair in 2 cases. Neither side effects nor abnormal values in laboratory findings were reported. The MIC of netilmicin against 14 strains of P. aeruginosa isolated from the above patients were distributed between 3.13 micrograms/ml and 12.5 micrograms/ml except 1 strain at inoculum size 10(6) cells/ml.

Topics: Aged; Drug Evaluation; Drug Resistance, Microbial; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections

Daily 150 mg or 200 mg dose of netilmicin (NTL) were administered to 26 patients with chronic complicated urinary tract infections for 5 days, and the following results were obtained. 1) Out of 26 cases excellent response was seen in 5 cases, good response in 4, and poor response in 11. Effectiveness rate was 45%. Six cases were excluded from the evaluation. 2) Effective result was not seen in the catheterized group, whereas 5 excellent and 4 good cases were observed in the noncatheterized group, resulting 60% in effectiveness rate. 3) MICs of NTL against various bacteria were comparative to GM against P. aeruginosa, to AMK against Serratia, and to both GM and AMK against other bacteria. 4) Except a slight local irritation, no subjective side effect was observed. One case showed a slight elevation in hepatic function tests but it was not definitely judged as the side effect due to NTL.

Topics: Adult; Aged; Bacteria; Chronic Disease; Drug Evaluation; Drug Resistance, Microbial; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Urinary 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

Aminoglycoside antibiotics are useful--despite potential toxicity--for treating urinary tract infection when other antibacterial agents have failed to eradicate bacteriuria. That this is true of the recently introduced aminoglycoside netilmicin was shown by 16 cases of tenacious and frequently recurring urinary tract infection. In contrast to previous recommendations, but relying on well known pharmacokinetic data which show prolonged urinary excretion of aminoglycosides, netilmicin was administered according to the following dosage schedule: Intramuscular injections of 3 mg/kg in cases where renal function was unimpaired, and of 2 mg/kg where it was reduced, were administered at dosage intervals of 1 to 4 days. Peak serum levels of netilmicin measured 1 hour after intramuscular injection were within the expected range of 8-14 micrograms/ml (3 mg/kg) and 6-10 micrograms/ml (2 mg/kg). As a result of the long dosage intervals the serum trough levels were usually far below 1 microgram/ml except in patients with moderate renal failure. Urinary concentrations of netilmicin, however, remained for the most part above the limit of antibacterial activity throughout the dosage intervals of 1 to 4 days. One week after the usual three weeks treatment course, urinary concentrations were still between 1 and 5 mcg/ml, and slowly decreasing amounts of the drug could be detected at least in traces up to 3 months beyond the last dose. Considering the type of urinary tract infections selected to receive netilmicin, the response to treatment was satisfactory and seemed unaffected by the long dosage intervals. Bacteriological cure was achieved in 5 of 11 infections associated with chronic pyelonephritis or analgesic nephropathy and in 4 of 5 urinary infections in patients with renal transplants. Treatment failures could be accounted for by obstructive lesions, stones, and in one transplanted patient by infection localized to her own shrunken kidneys. No instance of ototoxicity or nephrotoxicity due to netilmicin could be detected. Netilmicin administered according to the dosage schedule described can be recommended for ambulatory treatment of tenacious, recurring urinary tract infections due to gram-negative bacteria and refractory to cure by the usual oral antibiotic therapy.

Topics: Drug Administration Schedule; Female; Gentamicins; Humans; Male; Netilmicin; Urinary Tract Infections

Netilmicin was administered to 1 case of simple acute pyelonephritis and 21 cases of complicated urinary tract infections, 22 cases in total, and the effects were evaluated clinically. Total clinical effects of netilmicin evaluated by the UTI standard for evaluation of drug effects showed 61.9% of clinical effectiveness in 21 cases, and the results are satisfactory because 11 cases out of 21 cases were catheterized. The result was examined bacteriologically; the frequency of detection of particular strains among 23 strains clinically isolated from complicated urinary tract infections was that 10 strains of P. aeruginosa (43.5%), 3 of S. marcescens (13.0%), and 3 of E. coli (13.0%), and the ratios of bacteriologically disappeared strains were 70%, 33.3% and 66.7%, respectively, and the overall disappearance ratio was 73.9%. The MIC's determined for 17 strains and disappearance of the bacteria were examined; when MIC was less than 6.25 mcg/ml, 10 strains out of 12 disappeared, that is, 83% of disappearance was obtained. When MIC was larger than 100 mcg/ml, 2 strains out of 5 disappeared, that is, 40% of disappearance was obtained. Disappeared 2 strains of bacteria were isolated from patients who were not catheterized. Neither subjective symptoms nor abnormal laboratory findings related to the drug were observed. It may be said from these findings that netilmicin is an effective drug for urinary tract infections.

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

Patients with exacerbations of chronic urinary tract infection due to Pseudomonas aeruginosa were treated for 10 days with either ceftazidime or netilmicin. Bacteriuria was eliminated in all 15 patients who received ceftazidime but recurred in 11. Of 13 patients treated with netilmicin, pseudomonas was eradicated in eight but recurred in six.

Topics: Adult; Aged; Anti-Bacterial Agents; Blood Cell Count; Blood Chemical Analysis; Ceftazidime; Female; Humans; Male; Middle Aged; Netilmicin; Pseudomonas Infections; Urinary Tract Infections

Topics: Adult; Child; Creatinine; Double-Blind Method; Enzymes; Female; Gentamicins; Humans; Kidney Diseases; Middle Aged; Netilmicin; Urinary Tract Infections

Netilmicin is a new aminoglycoside antibiotic with pharmacological similarities to gentamicin, tobramycin and sisomicin. Fourteen of 15 patients with a severe or complicated urinary tract infection were cured by treatment with a seven day course of netilmicin. In one patient the infecting organism was not eradicated. No significant side effects were noted and no ototoxicity was detected. Four patients had a significant, but reversible, deterioration in renal function as defined by an increase in the plasma creatinine of 0.03 mmol/l or greater. Work in experimental animals has shown netilmicin to be significantly less ototoxic and nephrotoxic than other clinically available aminoglycosides. If this finding is confirmed in large-scale comparative trials in man, netilmicin should prove a most useful and effective new antibiotic for the treatment of severe gram-negative sepsis.

Topics: Adult; Aged; Creatinine; Female; Gentamicins; Glomerular Filtration Rate; Humans; Kidney; Male; Middle Aged; Netilmicin; Urinary Tract Infections

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

Netilmicin was investigated in the treatment of complicated urinary tract infection in 169 elderly male patients. It was found to be safe and effective at the dose levels of 1.0-2.5 mg/kg, three times a day, or 2 mg/kg twice a day, eliminating approximately 50-60% of the infections. The serum half-life of netilmicin was 2-3 hours in subjects with normal renal function but increased to 10-14 hours in subjects with severe uremia. When the dosage was adjusted according to the patient's weight and serum creatinine, some nephrotoxicity occurred, possibly due to drug accumulation. Therefore, we suggest that the dose be adjusted according to reduction in creatinine clearance and when possible, monitoring serum concentrations during treatment.

Topics: Aged; Amikacin; Gentamicins; Humans; Kinetics; Male; Middle Aged; Netilmicin; Tobramycin; Urinary Tract Infections

29 patients with serious renal or urinary tract infections were treated with netilmicin (initial dose 1.5 mg/kg twice daily). All but two patients were bacteriologically cured and responded well clinically. 13 patients with initial renal impairment were analysed separately. Whereas the patients with initial normal renal function did not show any increase of serum creatinine levels during and after treatment, the patients with renal impairment showed a significant increase of serum creatinine during the course of treatment, but no clinical signs of renal function deterioration. During the follow-up period (18 months), serum creatinine values in all cases but one returned to the pretreatment levels. Thus, the investigation revealed that netilmicin had a good clinical and bacteriological effect without signs of persistent renal damage.

Topics: Adult; Aged; Creatinine; Female; Gentamicins; Humans; Kidney Diseases; Male; Middle Aged; Netilmicin; Pyelonephritis; Renal Dialysis; Sepsis; Urinary Tract Infections

25 patients were treated with netilmicin because of suspected or verified septicaemia or other severe infections. Netilmicin was administered intramuscularly in a dose of 2 mg/kg body weight every 8 hours. For patients with elevated plasma creatinine the dosage was reduced according to the degree of elevation. Average length of treatment was 7 days (3-12 days). In 22 patients all symptoms and signs of infection disappeared. In one patient antibiotic treatment had to be changed and in two patients abscesses had to be surgically drained. Kidney function was monitored during and after treatment by plasma creatinine measurements and 51Cr-EDTA clearance. Netilmicin was discontinued in 4 patients because of an increase in plasma creatinine but little or no drug related nephrotoxicity was observed. Audio-vestibular function was monitored during and after treatment. Netilmicin was discontinued in one patient because of slight subjective loss of hearing. Subsequent audio-vestibular examination was normal.

Topics: Adult; Aged; Creatinine; Dizziness; Drug Evaluation; Female; Gentamicins; Hearing Loss; Humans; Male; Middle Aged; Netilmicin; Sepsis; Urinary Tract Infections

Sixteen patients with chronic or recurrent urinary tract infections, 14 with septicaemia, 2 with salmonellosis, 2 with pneumonia and 1 with acute mastitis were treated with 200 mg (2.2-3.6 mg/kg) netilmicin intramuscularly every 8 hours for 7-10 days (mean 8.8 days). 28 patients were cured, 5 showed marked improvement and 2 patients with septicaemia and severe underlying diseases failed to respond to treatment. The bacterial isolates were inhibited by 4.0 mg netilmicin/l or less. Antibiotic serum level determinations were performed in 32 patients. Mean serum concentrations of netilmicin 1 and 8 hours after injection were 12.6 and 2.0 mg/l respectively in 27 patients with normal serum creatinine levels. In 5 patients with elevated serum creatinine, mean peak and trough values were 21.5 and 5.8 mg/l, respectively. Mean netilmicin concentrations in serum and skin blister fluid obtained from 4 patients were equal 2-3 hours after injection, indicating appropriate tissue penetration. Nephrotoxicity occurred in 2 patients. Ototoxicity was not demonstrated. Netilmicin appears to be an effective and safe drug in the treatment of a variety of bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Chronic Disease; Creatinine; Drug Evaluation; Female; Gentamicins; Hearing; Humans; Male; Middle Aged; Netilmicin; Sepsis; Urinary Tract Infections

Netilmicin, a new semisynthetic aminoglycoside, was evaluated in the therapy of 33 episodes of infection in 30 patients. Eighteen patients had documented bacteremia. Infection sites included pulmonary, urinary tract and soft tissue areas. A complete bacteriologic and clinical cure rate of 85 per cent was achieved. No treatment failures occurred in the bacteremic group. Although netilmicin is less effective than gentamicin in vitro against Pseudomonas, it was clinically and bacteriologically effective. Netilmicin bacteriologic cures occurred in patients whose organisms were inhibited by 6.2 microgram/ml or less of netilmicin. Despite a uniform dosing protocol, a wide range of netilmicin serum levels was obtained. Adverse effects were limited to one case of transient nephrotoxicity and one Candida urinary suprainfection. Netilmicin appears to be an effective, safe agent for the therapy of serious infections.

Topics: Adult; Aged; Amikacin; Bacterial Infections; Female; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Sepsis; Urinary Tract Infections

A clinical trial involving forty hospitalized patients with urinary tract infections was conducted to compare the effectiveness and tolerance of four dosage regimens of netilmicin: 1, 2, 3, and 4 mg/kg administered twice daily for 7 or 8 days. Each of the dosages was effective and the first three were equally well tolerated. At 4 mg/kg there was one case of renal dysfunction possibly related to netilmicin therapy. Serum concentrations of the drug measured 1 hour after injection were dose-related, as were those measured 1 hour before administration; no appreciable accumulation occurred with any of the regimens.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Middle Aged; Netilmicin; Urinary Tract Infections

Topics: Gentamicins; Humans; Netilmicin; Urinary Tract Infections

Netilmicin, a new semisynthetic aminoglycoside antibiotic, was used to treat 41 infections in 38 patients. The outcome of four infections could not be evaluated: two patients received inadequate therapy and two did not have gram-negative infections. Clinical improvement occurred in 36 (97%) of the 37 gram-negative infections, and bacteriologic cure occurred in 30 (86%) of the 35 evaluable infections. Therapeutic serum concentrations of netilmicin were readily achieved by both intramuscular and intravenous routes. Reversible ototoxic effects occurred in 1 (3%) of 35 courses of therapy evaluated, reversible nephrotoxic effects occurred in 5 (14%) of 36 courses and mild reversible alterations in liver function occurred in 3 (19%) of 34 courses. Netilmicin appears to be effective and safe in the treatment of aerobic gram-negative infections.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Pseudomonas Infections; Urinary Tract Infections

Netilmicin, a new aminoglycoside antibiotic, was used to treat 19 patients with urinary tract infection and 5 with systemic infection. The causal organisms were Escherichia coli (in 2), Klebsiella pneumoniae (in 4), Serratia marcescens (in 12) and Pseudomonas aeruginosa (in 7); 1 patient was infected with two of these organisms. All the isolates of causal organisms except one of Serratia were initially sensitive to netilmicin but many were resistant to other aminoglycosides. Sixteen of the urinary tract infections responded to netilmicin therapy, although relapse occurred in three patients. Two of the three patients with musculoskeletal infection responded to combined therapy with surgery and netilmicin; the other patient responded to the same regimen but with carbenicillin added. Netilmicin cured pneumonia in one patient but failed in the other patient with pneumonia, who had leukemia. Superinfection occurred in five patients with urinary tract infection. Adverse reactions to netilmicin were minor. Netilmicin may prove to be a useful agent, particularly for infections due to multiresistant Klebsiella or Serratia, or when prolonged aminoglycoside therapy is required.

Topics: Adolescent; Adult; Aged; Amputation, Surgical; Aorta, Abdominal; Aortic Aneurysm; Drug Evaluation; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Gentamicins; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Netilmicin; Pneumonia; Pseudomonas aeruginosa; Pseudomonas Infections; Serratia marcescens; Surgical Wound Infection; Urinary 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

Netilmicin, a half-synthetic aminoglycoside, was given to 22 patients with urinary-tract infections at a dose of 2 mg/kg body weight twice daily intramuscularly for 7--9 days. Pharmacokinetics (in ten patients), efficacy and tolerance to the drug were analysed. Mean serum peak concentrations on the first and last days of treatment, was 8.7 microgram/ml at 45 min after injection, 9.5 microgram/ml after 60 min. After 12 hours the level had fallen to 0.8 microgram/ml and 1.2 microgram/ml, respectively. Mean half-life was 3.08 hours for the first and 3.57 hours for the last day. The corresponding mean values for plasma clearance were 53.6 ml/min and 42.4 ml/min, respectively. Within 12 hours an average of 77.6% and 78.0%, respectively, of the netilmicin dose were eliminated in the urine. The causative organism was eliminated in 12 of 16 patients with chronic or reccurent and in all six with acute urinary infections. There were two re-infections and two failures. Superinfection did not occur. Local and general tolerance was good and there were no signs of renal or inner-ear toxicity.

Topics: Adult; Aged; Female; Gentamicins; Humans; Injections, Intramuscular; Kinetics; Male; Middle Aged; Netilmicin; Time Factors; Urinary Tract Infections