NETILMICIN SULFATE
(ne-til-mye'sin)
Netromycin
Classifications: antiinfective; aminoglycoside antibiotic
Prototype: Gentamicin
Pregnancy Category: D

Availability

100 mg/mL injection

Actions

Rapid-acting, broad-spectrum, semisynthetic aminoglycoside derivative. Spectrum of activity comparable to that of gentamicin, but netilmicin is also effective against gentamicin-resistant bacteria. Not inactivated by most strains of bacteria resistant to other aminoglycosides.

Therapeutic Effects

Bactericidal action primarily against gram-negative organisms including Citrobacter, Enterobacter, Escherichia coli, Klebsiella, Proteus mirabilis, Pseudomonas aeruginosa, Salmonella, Serratia, and certain gram-positive bacteria such as Staphylococcus pyogenes and S. faecalis. Like other aminoglycosides, not effective against most anaerobic bacteria (Bacteroides and Clostridium species), viruses, or fungi.

Uses

Short-term treatment of serious or life-threatening infections including septicemia, peritonitis, intraabdominal abscess, lower respiratory tract infections, complicated urinary tract infection, and infections of bones, joints, and skin and its structures. May be administered in conjunction with a beta-lactam antibiotic (e.g., a penicillin or cephalosporin) for synergistic effect pending results of susceptibility testing.

Contraindications

History of hypersensitivity or toxic reaction to netilmicin or other aminoglycosides or to bisulfites or any other ingredient in the formulation; minor infections; pregnancy (category D), lactation.

Cautious Use

Impaired kidney function; premature infants, neonates, older adults; patients with ascites, edema, dehydration; severe burns; cystic fibrosis; fever; anemia; myasthenia gravis, parkinsonism; history of ear disease; infant botulism.

Route & Dosage

Note: All doses based on ideal body weight

Moderate to Severe Infections
Adult: IV/IM 1.3–2.2 mg/kg q8h or 2–3.25 mg/kg q12h
Child: IV/IM <6 wk, 2–3.5 mg/kg q12h; 6 wk–12 y, 1.8–2.7 mg/kg q8h or 2.7–4 mg/kg q12h

Renal Impairment
Cl_cr >70 mL/min: Reduce dose by multiplying maintenance dose by 0.85 and administer q8h; 50–69 mL/min: Reduce dose by multiplying maintenance dose by 0.85 and administer q12 h; 25–49 mL/min: Reduce dose by multiplying maintenance dose by 0.85 and administer q24h; <25 mL/min: Reduce dose by multiplying maintenance dose by 0.85 and administer doses based on serum concentrations

Complicated UTI
Adult: IV/IM 1.5–2 mg/kg q12h

Administration

Note: Determine doses for obese patient by using ideal body weight. Use manufacturer's guidelines to adjust doses for those with impaired kidney function.

Intramuscular

Give deep IM into a large muscle.

Intravenous

PREPARE: Intermittent: Adult, Dilute a single dose in 50–200 mL of D5W, NS, D5/NS, or RL. Pediatric, Dilute to concentration of 2–3 mg/mL.

ADMINISTER: Intermittent: Give over 30–120 min or as ordered.

INCOMPATIBILITIES Solution/additive: Cefepime, furosemide, heparin. Y-site: Allopurinol, amphotericin B cholesteryl complex, furosemide, propofol.

Do not use solutions that are discolored or that contain particulate matter.

Diluted solutions retain potency for up to 72 h when stored in glass containers at 15°–30° C (59°–86° F) or refrigerated.

Adverse Effects (1%)

CNS: Headache, lethargy, drowsiness, paresthesias, tremors, muscle twitching, peripheral neuritis, disorientation, seizures, neuromuscular blockade; musculoskeletal weakness or paralysis, respiratory depression or paralysis. CV: Palpitation, hypotension. Special Senses: Ototoxicity (usually irreversible; eighth cranial nerve auditory branch: tinnitus, hearing loss, ringing, buzzing or fullness in ears; vestibular branch: vertigo, nystagmus, ataxia, nausea, and vomiting), blurred vision. GI: Nausea, vomiting, diarrhea, stomatitis, proctitis, enterocolitis. Hematologic: Increases in ALT, AST, alkaline phosphatase, bilirubin; anemia, eosinophilia, neutropenia, thrombocytopenia, thrombocytosis, agranulocytosis, leukopenia, leukemoid reaction. Skin: Rash, pruritus, induration, and hematoma at injection site. Urogenital: Nephrotoxicity, increase in serum creatinine and BUN; decrease in creatinine clearance; hematuria, proteinuria, urinary frequency, oliguria, polyuria. Body as a Whole: Fever, edema, arthralgia; pain, Metabolic: Hypokalemia.

Diagnostic Test Interference

Concomitant netilmicin-cephalosporin therapy may cause false elevations of creatinine determinations. Concomitant use of BETA-LACTAMS (cephalosporins, penicillins) may result in falsely low aminoglycoside levels (mutual inactivation may continue in body fluid specimen unless promptly assayed, or frozen, or treated with beta-lactamase).

Interactions

Drug: anesthetics, skeletal muscle relaxants add to neuromuscular blocking effects; acyclovir, amphotericin B, bacitracin, capreomycin, cephalosporins, colistin, cisplatin, carboplatin, methoxyflurane, polymyxin B, vancomycin, furosemide, ethacrynic acid increase risk of ototoxicity or nephrotoxicity or both.

Pharmacokinetics

Peak: End of IV infusion; 30–60 min IM. Distribution: Does not cross blood–brain barrier; accumulates in renal cortex; crosses placenta; distributed into breast milk. Elimination: Excreted in urine. Half-Life: 2–2.5 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Perform C&S tests prior to initiation of therapy. Therapy may begin before test results are available; baseline and periodic kidney function tests; peak and trough drug levels.
Monitor high-risk patients closely (i.e., kidney function impairment: older adults, dehydrated patients, burn patients, and patients receiving high doses or prolonged therapy).
Determine peak serum drug levels by drawing blood 1 h after IM injection or IV infusion begins. To determine trough serum drug levels, draw blood just before next scheduled dose. Desirable peak values: 6–10 mcg/mL; desirable trough values: 0.5–2 mcg/mL. Peak values >16 mcg/mL and trough values >4 mcg/mL are associated with a high potential for toxicity.
Note: Close monitoring of serum drug concentrations is especially important for patients with fever, edema, severe burns, and anemia. Peak serum drug levels tend to be significantly reduced in these patients.
Monitor I&O ratio and pattern and report significant changes. Keep patient well hydrated throughout therapy to minimize possibility of chemical irritation of renal tubules and to reduce risk of toxicity.
Evaluate patients before and during therapy for hearing acuity and vestibular status. Notify physician promptly if patient complains of any hearing loss, tinnitus, vertigo, or ataxia.
Repeat bacterial susceptibility tests if therapeutic effectiveness is not evident within 3–5 d.
Watch for S&S of superinfection (see Appendix F), especially of upper respiratory tract. Also suspect overgrowth of opportunistic organisms if patient develops sore rectum, diarrhea, vaginal discharge, sore mouth, fever.

Patient & Family Education

Report to physician immediately any roaring sounds or ringing in the ears.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug