Name of the Systematic Aminoglycosides Drugs
- Streptomycin
- Getamicin
- Kanamycin
- Tobramycin
- Amikacin
- plazomicin
- Paromomycin
1.Streptomycin
| Streptomycin |
| Availability Injection: 400 mg/ml in 2.5-ml ampules, 200 mg/ml in 1-g vials |
| Indications and dosages Adjunct in tuberculosis and other mycobacterial infections Adults: 15 mg/kg/day I.M., up to 1 g/day Children: 20 to 40 mg/kg I.M. daily, up to 1 g/day Enteroccocal or streptococcal infections Adults: 1 g I.M. b.i.d. for 1 week, then 500 mg I.M. b.i.d. for 1 week. For enterococcal endocarditis, 1 g I.M. b.i.d. given with penicillin for 1 week, then 500 mg I.M. b.i.d. for 4 weeks. Brucellosis Adults: 1 g I.M. once or twice daily with tetracycline or doxycycline for 1 week, then once daily for at least 1 more week Tularemia Adults: 1 to 2 g I.M. daily in divided doses for 7 to 14 days until patient is afebrile for 5 to 7 days. For tularemia caused by Francisella tularensis, 1 g I.M. b.i.d. for 10 days or 7.5 to 10 mg/ kg I.M. b.i.d. for 10 to 14 days. Plague caused by Yersinis pestis Adults: 1 g I.M. b.i.d. for 10 to 14 days |
Mechanism of Action
Binds to negatively charged sites on the bacteria’s outer cell membrane, disrupting cell integrity. Streptomycin also binds to bacterial ribosomal subunits and inhibits protein synthesis. Both actions lead to bacterial cell death.
Pharmacokinetics
- Absorption: IM: well absorbed; not absorbed from gut
- Distribution: to extracellular fluid including serum, abscesses, ascitic, pericardial, pleural, synovial, lymphatic, & peritoneal fluids; crosses placenta; small amounts enter breast milk
- Protein Bound: 34%
- Half-life elimination: newborns: 4-10 hr; adults: 2-4.7 hr, prolonged with renal impairment
- Peak Plasma Time: within 1 hr
- Excretion: urine (90% as unchanged drug); feces, saliva, sweat, & tears (<1%)
Administration
- Inject I.M. deep into upper outer quadrant of buttock.
- Alternate injection sites.
- Know that drug may be given with other antituberculars.
- Be aware that streptomycin will be withdrawn after several months or when bacteriologic smears are negative and other antituberculars are continued for 1 year
Contraindications
Hypersensitivity to drug, other aminoglycosides, or bisulfites
Precautions :
- Renal impairment, hearing impairment, neuromuscular disease (such as myasthenia gravis)
- Elderly patients
- Pregnant or breastfeeding patients
- Infants and neonates (safety not established).
Adverse reactions
- CNS: vertigo, numbness and tingling, peripheral neuropathy, myasthenia gravis–like syndrome, neuromuscular blockade, seizures
- CV: myocarditis
- EENT: amblyopia, ototoxicity GI: nausea, vomiting
- GU: azotemia, nephrotoxicity
- Hematologic: eosinophilia, hemolytic anemia, pancytopenia, leukopenia, thrombocytopenia
- Hepatic: hepatic necrosis
- Musculoskeletal: muscle weakness, twitching Respiratory: apnea Skin: rash, urticaria, exfoliative dermatitis, toxic epidermal necrolysis, angioedema
- Other: fever, superinfection, serum sickness, anaphylaxis
Patient monitoring
- Draw blood for peak drug level 1 hour after I.M. injection. Draw blood for trough level just before next dose.
- Monitor liver and kidney function tests. Watch for evidence of hepatotoxicity and nephrotoxicity.
- Monitor temperature. Stay alert for fever and other signs and symptoms of superinfection.
- Assess neurologic status and sensory function carefully. Watch closely for neurotoxicity, neuromuscular blockade, and seizures.
- Assess for signs and symptoms of ototoxicity.
- Monitor CBC. Watch for evidence of blood dyscrasias.
Patient teaching
- Instruct patient to report unusual bleeding or bruising.
- Inform patient that drug can be toxic to many body systems. Teach him to recognize and immediately report serious adverse reactions.
- Tell patient drug may promote growth of certain organisms. Advise him to immediately report signs and symptoms of superinfection.
- Inform patient that drug may impair cognitive, motor, and sensory function.
- Advise him to use caution when driving and performing other hazardous activities.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Nursing Considerations
- Use streptomycin cautiously in patients with renal impairment. In severely uremic patients, single dose can produce high blood level of drug for several days; cumulative effects may produce ototoxicity.
- Expect prescriber to order baseline renal function studies and to assess cranial nerve VIII function (responsible for hearing) at start of streptomycin therapy to allow for later comparisons.
- Monitor serum peak and trough levels, as ordered, to ensure adequate but not toxic drug level.
- Be aware that streptomycin should be given only by I.M. injection.
- To reconstitute streptomycin, add between 4.2 and 4.5 ml of sodium chloride for injection or sterile water for injection to each 1-g vial to provide a concentration of 200 mg/ml, or add between 3.2 and 3.5 ml of diluent to each 5-g vial to provide a concentration of 250 mg/ml. Alternatively, add 6.5 ml of diluent to each 5-g vial to provide a concentration of 500 mg/ml.
- Don’t give more than 500 mg/ml.
- Rotate injection sites to prevent sterile abscess formation
2.Getamicin
| Getamicin |
| Availability Cream: 0.1% Injection: 10 mg/ml (pediatric), 40 mg/ ml (adult) I.V. infusion (premixed in normal saline solution): 40 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 120 mg Ointment: 0.1% Ointment (ophthalmic): 0.3% (base) Solution (ophthalmic): 0.3% (base) |
| Indications and dosages Serious infections caused by Pseudomonas aeruginosa, Escherichia coli, and Proteus, Klebsiella, Serratia, Enterobacter, Citrobacter, or Staphylococcus species Adults: 3 mg/kg/day in three divided doses I.M. or I.V. infusion q 8 hours. For life-threatening infections, up to 5 mg/kg/day in three to four divided doses; reduce to 3 mg/kg/day as indicated. Children: 2 to 2.5 mg/kg q 8 hours I.M. or I.V. infusion Infants older than 1 week: 2.5 mg/kg q 8 hours I.M. or I.V. infusion Neonates younger than 1 week, preterm infants: 2.5 mg/kg q 12 hours I.M. or I.V. infusion. In preterm infants of less than 32 weeks’ gestational age, 2.5 mg/kg q 18 hours or 3 mg/kg q 24 hours also may produce satisfactory peak and trough blood levels. Endocarditis prophylaxis before surgery Adults: 1.5 mg/kg I.M. or I.V. 30 minutes before surgery, to a maximum of 80 mg. As prescribed, give with ampicillin or vancomycin. Children: 2 mg/kg I.M. or I.V. 30 minutes before surgery, to a maximum of 80 mg External ocular infections caused by susceptible organisms Adults and children: One to two drops of ophthalmic solution in eye q 4 hours. For serious infections, up to two drops q hour, or ophthalmic ointment applied to lower conjunctival sac two to three times daily. Treatment and prevention of superficial burns caused by susceptible bacteria Adults and children older than age 1: Gently rub small a amount of drug topically on affected area three or four times daily. |
Mechanism of Action
Binds to negatively charged sites on the outer cell membrane of bacteria, thereby disrupting the membrane’s integrity. Gentamicin also binds to bacterial ribosomal subunits and inhibits protein synthesis. Both actions lead to cell death.
Pharmacokinetics:
- Distribution: Gentamicin crosses placenta; relative diffusion from blood into CSF is minimal even with inflammation
- Protein Bound: <30%
- Half-life elimination: 2-3 hr (NRF)
- Peak Plasma Time: IM (30-90 min); IV (30 min after 30-min infusion)
- Excretion: Urine (70% recovered as unchanged drug in patients with NRF)
Administration
- Before starting therapy, obtain specimens as needed for culture and sensitivity testing.
- For I.V. infusion, dilute with 50 to 200 ml of dextrose 5% in water (D5W) or normal saline solution, and administer over 30 minutes to 2 hours.
- After infusion, flush line with normal saline solution or D5W.
- Obtain peak drug blood level 30 minutes after 30-minute infusion; obtain trough level within 30 minutes of next scheduled dose.
- Give cephalosporin or parenteral penicillin 1 hour before or after gentamicin, as prescribed.
- Know that for topical treatment of burns, gauze dressings may be applied.
Contraindications
Hypersensitivity to drug or other aminoglycosides
Precautions :
- neuromuscular disease, renal impairment, hearing impairment
- sulfite sensitivity (with parenteral use)
- obese patients
- elderly patients
- pregnant or breastfeeding patients
- infants, neonates, and premature infants.
Adverse reactions
- CNS: dizziness, vertigo, tremors, numbness, depression, confusion, lethargy, headache, paresthesia, neuromuscular blockade, seizures, neurotoxicity
- EENT: visual disturbances, dry eyes, nystagmus, photophobia, ototoxicity, hearing loss, tinnitus
- GI: nausea, vomiting, stomatitis, increased salivation, splenomegaly, anorexia
- GU: increased urinary casts, polyuria, dysuria, erectile dysfunction, azotemia, nephrotoxicity
- Hematologic: eosinophilia, leukemoid reaction, hemolytic anemia, aplastic anemia, neutropenia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia
- Hepatic: hepatomegaly, hepatotoxicity, hepatic necrosis
- Musculoskeletal: joint pain, muscle twitching
- Respiratory: apnea
- Skin: exfoliative dermatitis, rash, pruritus, urticaria, purpura, alopecia
- Other: weight loss, superinfection, pain and irritation at I.M. injection site
Patient monitoring
- Watch for signs and symptoms of hypersensitivity reactions.
- Know that drug blood level monitoring is especially important in therapy lasting more than 5 days, acute or chronic renal impairment, extracellular fluid volume changes, obesity, infants younger than 3 months, concomitant use of nephrotoxic drugs, patients requiring higher doses or dosage interval adjustments (such as those with cystic fibrosis, endocarditis, or critical illness), and patients with signs or symptoms of nephrotoxicity or ototoxicity.
- Assess fluid intake and output, urine specific gravity, and urinalysis for signs of nephrotoxicity.
- Monitor CBC, BUN, creatinine level, and creatinine clearance.
- Weigh patient regularly.
- Assess for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo).
Patient teaching
- Teach patient to recognize and immediately report signs and symptoms of hypersensitivity reaction, infection, unusual tiredness, yellowing of skin or eyes, and muscle twitching.
- Advise patient to report signs and symptoms of ototoxicity (hearing loss, ringing in ears, vertigo).
- Instruct patient to drink plenty of fluids to ensure adequate urine output.
- Tell patient to monitor urine output and report significant changes.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Nursing Considerations
- Before gentamicin therapy begins, expect to obtain a body fluid or tissue specimen for culture and sensitivity testing, as ordered, or check test results, if available.
- Drug is best absorbed when given by I.V. route. Blood level is unpredictable after I.M. administration.
- For I.V. use, dilute each dose with 50 to 200 ml normal saline solution or D5W to yield no more than 1 mg/ml. Administer slowly over 30 to 60 minutes.
- Don’t give gentamicin through same I.V. line as other drugs without first consulting pharmacist.
- Expect to adjust dosage based on peak and trough blood drug levels drawn after third maintenance dose, as prescribed.
- Don’t give gentamicin by subcutaneous route because it may be painful.
- When assisting with intrathecal injection, use only 2 mg/ml of preservative-free preparation. Drug may be injected directly or delivered by implanted reservoir.
- Don’t give drug to pregnant patient because it can cause hearing loss in fetus.
- Assess patient for evidence of other infections because gentamicin may cause overgrowth of nonsusceptible organisms. Be aware that premature infants, neonates, and elderly patients have an increased risk of nephrotoxicity
3.Kanamycin
| Kanamycin |
| Indications and Dosages To treat infections caused by gram-negative organisms (including Acinetobacter species, Enterobacter aerogenes, Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria species, Proteus species, Providencia species, Salmonella species, Serratia marcescens, Shigella species, and Yersinia species) and gram-positive organisms (including Staphylococcus aureus and Staphylococcus epidermidis) I.M. INJECTION Adults and children. 3.75 mg/kg every 6 hr, 5 mg/kg every 8 hr, or 7.5 mg/kg every 12 hr for 7 to 10 days. Maximum: 1.5 g daily. I.V. INFUSION Adults and children. 5 mg/kg every 8 hr or 7.5 mg/kg every 12 hr for 7 to 10 days. Maximum: 1.5 g daily As adjunct to suppress intestinal bacterial growth CAPSULES Adults. 1 g/hr for 4 hr and then 1 g every 6 hr for 36 to 72 hr To treat hepatic coma CAPSULES Adults. 8 to 12 g daily in divided doses To treat respiratory tract infection INHALATION NEBULIZER Adults. 250 mg b.i.d. to q.i.d. Maximum: 1.5 g daily |
Mechanism of Action
Binds to negatively charged sites on bacterial outer cell membranes, which disrupts cell membrane integrity. Kanamycin also binds to bacterial ribosomal subunits and inhibits protein synthesis; these actions lead to cell death.
Contraindications
Hypersensitivity to kanamycin, other aminoglycosides, or their components; intestinal obstruction (oral form)
Pharmacokinetics:
Metabolism: unknown
Excretion: urine
Adverse Reactions
- CNS: Ataxia, dizziness, headache
- EENT: Hearing loss
- GI: Diarrhea
- GU: Elevated BUN and serum creatinine levels, oliguria, proteinuria
- MS: Muscle paralysis
- RESP: Apnea
- SKIN: Injection site irritation or pain
Nursing Considerations
- Obtain body fluid or tissue specimen for culture and sensitivity testing before kanamycin therapy begins, as indicated. Therapy may begin before test results are available.
- Administer I.M. injection deep into upper outer quadrant of gluteus maximus. Rotate injection sites.
- Be aware that oral kanamycin is minimally absorbed from intact GI mucosa but may be more absorbed from mechanically irrigated areas of the GI tract.
- For I.V. use, dilute 500-mg vial with 100 to 200 ml normal saline solution or D5W, or 1-g vial with 200 to 400 ml normal saline solution or D5W, and infuse over 30 to 60 min. Vial contents may darken during storage but potency isn’t affected.
- Keep patient well hydrated before and during therapy.
- Monitor blood kanamycin level periodically during therapy, as appropriate.
- Prolonged treatment increases risk of ototoxicity and nephrotoxicity. Monitor hearing and renal function if therapy lasts longer than 10 days.
Patient Teaching
Explain need to take kanamycin at prescribed intervals around the clock until patient completes full course of therapy.
Advise patient to report dizziness, hearing loss, and severe diarrhea or headache.
4.Tobramycin
| Tobramycin |
| Availability Injection: 10 mg/ml, 40 mg/ml, 1.2-g vial Nebulizer solution: 300 mg/5 ml in 5-ml ampule Ophthalmic ointment: 0.3% Ophthalmic solution: 0.3% Pediatric solution for injection: 20 mg/ 2 ml Premixed I.V. solution: 60 mg in 50 ml normal saline, 80 mg in 100 ml normal saline |
| Indications and dosages Serious infections caused by susceptible organisms Adults: 3 mg/kg/day I.V. or I.M. in evenly divided doses q 8 hours. For lifethreatening infections, may increase up to 5 mg/kg/day I.V. or I.M. in three or four evenly divided doses, then reduce to 3 mg/kg/day as soon as possible. Children older than 1 week: 6 to 7.5 mg/kg/day in three or four evenly divided doses, such as 2 to 2.5 mg/kg I.V. or I.M. q 8 hours or 1.5 to 1.9 mg/kg I.V. or I.M. q 6 hours Neonates less than 1 week old: Up to 4 mg/kg/day I.V. or I.M. in evenly divided doses q 12 hours Pseudomonas aeruginosa in cystic fibrosis patients Adults and children older than age 6: 300 mg inhalation b.i.d. (preferably q 12 hours but no less than 6 hours apart) for 28 days, then off for 28 days; then repeat cycle Ocular infections caused by susceptible organisms Adults and children: For mild to moderate infections, apply a ribbon of ophthalmic ointment (approximately 1 cm) to infected eye two or three times daily, or instill one to two drops of ophthalmic solution into infected eye q 4 hours. For severe infections, apply ophthalmic ointment q 3 to 4 hours or instill two drops of ophthalmic solution into infected eye q 30 to 60 minutes; decrease dosing frequency when improvement occurs. Therapy should continue for at least 48 hours after infection is under control. Inhibits bacterial protein synthesis by binding irreversibly to one of two aminoglycoside-binding sites on the 30S ribosomal subunit, resulting in bacteriostatic effects. Bactericidal effects may stem from tobramycin’s ability to accumulate within cells so that the intracellular drug level exceeds the extracellular level. |
Pharmacokinetics:
- Absorption: IM: rapid and complete
- Distribution: to extracellular fluid including serum, abscesses, ascitic, pericardial, pleural, synovial, lymphatic, and peritoneal fluids; crosses placenta; poor penetration into CSF, eye, bone, prostate
- Protein Bound: <30%
- Half-life elimination: 2-3 hr (normal renal function)
- Peak Plasma Time: IM: 30-60 min; IV: ~30 min
- Excretion: ~90%-95% in urine within 24 hr (normal renal function)
Administration
- Know that premixed I.V. solution is ready to use and requires no further dilution. Don’t mix with other drugs. 2Don’t use flexible container in series connections because of risk of air embolism.
- Dilute I.V. dose from vials in 50 to 100 ml of normal saline solution or dextrose 5% in water. For child, smaller volumes are needed.
- Infuse over at least 30 minutes. Flush line after administration.
- Give cephalosporins or penicillin, if ordered, 1 hour before or after tobramycin.
- Give inhalation doses by nebulizer over 10 to 15 minutes.
Contraindications
Hypersensitivity to drug, other aminoglycosides, bisulfites (with some products), or benzyl alcohol (in neonates, with some products)
Precautions:
- Renal or hearing impairment, neuromuscular diseases, obesity
- Elderly patients
- Pregnant or breastfeeding patients
- Neonates and premature infants.
Adverse reactions
- CNS: confusion, lethargy, headache, delirium, dizziness, vertigo
- EENT: eye stinging (with ophthalmic form), ototoxicity, hearing loss, roaring in ears, tinnitus
- GI: nausea, vomiting, diarrhea, stomatitis
- GU: proteinuria, oliguria, nephrotoxicity
- Hematologic: anemia, eosinophilia, leukocytosis, leukopenia, thrombocytopenia, granulocytopenia
- Metabolic: hypocalcemia, hyponatremia, hypokalemia, hypomagnesemia
- Musculoskeletal: muscle weakness
- Respiratory: apnea
- Skin: rash, urticaria, itching
- Other: superinfection, fever, pain and irritation at injection site
Patient monitoring
- Draw sample for peak drug level 1 hour after I.M. or 30 minutes after I.V. administration. Draw sample for trough level just before next dose.
- Assess liver and kidney function tests.
- Monitor CBC with white cell differential.
- Closely monitor patient’s hearing.
Patient teaching
- Tell patient drug may cause hearing impairment and other serious adverse reactions, such as unusual bleeding or bruising. Instruct him to report these reactions at once.
- Advise patient to report new signs or symptoms of infection.
- With inhalation form, teach patient how to use nebulizer. Instruct him to administer dose over 10 to 15 minutes by breathing normally through mouthpiece while sitting or standing. Remind him to use only the hand-held nebulizer and compressor originally dispensed with drug. Advise him to use a nose clip to help him breathe through his mouth. If he uses other inhaled drugs, instruct him to take tobramycin last.
- Teach patient proper use of eye drops. Caution him not to touch dropper to eye or any other surface.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Nursing Considerations
- Obtain fluid and tissue samples for culture and sensitivity testing before and during tobramycin therapy, as ordered. Review results, if available, before therapy starts.
- After reconstituting with 30 ml of sterile or bacteriostatic water for injection, dilute further with normal saline solution or D5W.
- Give each I.V. dose over 20 to 60 minutes
- Don’t expose ampules for inhalation solution to intense light. Refrigerate them at 36° to 46° F (2° to 8° C).
- Because drug can cause bilateral and irreversible hearing loss, assess for early signs of cochlear and vestibular ototoxicity, including high-frequency hearing loss and vertigo.
- Monitor serum calcium, magnesium, potassium, and sodium levels to detect electrolyte imbalances.
5.Amikacin
| Amikacin |
| Availability Injection: 50 mg/ml, 250 mg/ml |
| Indications and dosages Severe systemic infections caused by sensitive strains of Pseudomonas aeruginosa, Escherichia coli, or Proteus, Klebsiella, Serratia, Enterobacter, Actinobacter, Providencia, Citrobacter, or Staphylococcus species Adults, children, and older infants: 15 mg/kg/day I.V. or I.M. in two to three divided doses q 8 to 12 hours in 100 to 200 ml of dextrose 5% in water (D5W) over 30 to 60 minutes. Maximum dosage is 1.5 g/day. Neonates: Initially, 10 mg/kg I.M., then 7.5 mg/kg I.M. q 12 hours Uncomplicated urinary tract infections caused by susceptible organisms Adults, children, and older infants: 250 mg I.M. or I.V. twice daily |
Mechanism of Action
Binds to negatively charged sites on bacteria’s outer cell membrane, disrupting cell integrity. Also binds to bacterial ribosomal subunits and inhibits protein synthesis. Both actions lead to cell death.
Administration
- Don’t physically mix amikacin with other drugs. Administer separately.
- For I.V. use, dilute in 100 to 200 ml of normal saline solution or D5W and give over 30 to 60 minutes.
- Ensure adequate fluid intake to avoid dehydration.
- Draw peak blood level 1 hour after I.M. infusion or 30 to 60 minutes after I.V. infusion.
- Draw trough blood level just before next dose.
Contraindications
- Hypersensitivity to aminoglycosides
- Breastfeeding
Pharmacokinetics:
Absorption: May be delayed in bedridden patient
Protein Bound:0-11%
Half-life elimination: 2-3 hr (normal renal function)
Peak Plasma Time: IM: 45-120 min
Excretion: urine (94-98%)
Precautions:
- Decreased renal function, neuromuscular disorders
- Parkinsonism, myasthenia gravis
- Concurrent or serial use of other nephrotoxic and ototoxic drugs
- Elderly patients
- Pregnant patients.
Adverse reactions
- CNS: dizziness, vertigo, tremor, numbness, depression, confusion, lethargy, headache, paresthesia, ataxia, neuromuscular blockade, seizures, neurotoxicity
- CV: hypotension, hypertension, palpitations
- EENT: nystagmus and other visual disturbances, ototoxicity, hearing loss, tinnitus
- GI: nausea, vomiting, splenomegaly, stomatitis, increased salivation, anorexia
- GU: azotemia, increased urinary excretion of casts, polyuria, painful urination, impotence, nephrotoxicity
- Hematologic: purpura, eosinophilia, leukemoid reaction, aplastic anemia, neutropenia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, hemolytic anemia
- Hepatic: hepatomegaly, hepatic necrosis, hepatotoxicity
- Musculoskeletal: joint pain, muscle twitching
- Respiratory: apnea
- Skin: rash, alopecia, urticaria, itching, exfoliative dermatitis
- Other: weight loss, superinfection, pain and irritation at I.M. site
Patient monitoring
- Monitor kidney function test results and urine cultures, output, protein, and specific gravity.
- Monitor results of peak and trough drug blood levels.
- Evaluate for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo).
- Assess for secondary superinfections, particularly upper respiratory tract infections.
Patient teaching
- Inform patient that drug may cause hearing loss, seizures, and other neurologic problems. Tell him to report these symptoms immediately
- Instruct patient to immediately report fever, cough, breathing problems, sore throat, and other signs and symptoms of infection.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
- Instruct patient to notify prescriber if he’s urinating much more or much less than normal.
- Advise patient to minimize GI upset by eating small, frequent servings of food, and drinking plenty of fluids.
- Inform patient that he’ll undergo regular blood and urine testing during therapy.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Nursing Considerations
- Expect to obtain results of culture and sensitivity testing before therapy begins.
- Prepare amikacin I.V. solution by adding contents of 500-mg vial to 100 to 200 ml of sterile diluent. Then infuse drug over 30 to 60 minutes.
- Give I.M. injection in large muscle mass.
- Watch for signs of ototoxicity, such as tinnitus and vertigo, especially during highdosage or prolonged amikacin therapy
- Be aware that amikacin may exacerbate muscle weakness in such conditions as myasthenia gravis and Parkinson’s disease.
- Measure serum amikacin concentrations as ordered, usually 30 to 90 minutes after injection (for peak concentration) and just before administering next dose (for trough concentration).
6.Plazomicin
| Plazomicin |
| Availability injection, single-dose vial 500mg/10mL (50mg/mL |
| Indications and dosages Complicated Urinary Tract Infections 15 mg/kg IV q24hr infused over 30 minutes |
Mechanism of Action
Plazomicin sulfate is a semisynthetic aminoglycoside antibacterial derived from sisomicin
Engineered to overcome aminoglycoside-modifying enzymes (AMEs), the most common aminoglycoside-resistance mechanism in Enterobacteriaceae, and has in vitro activity against extended-spectrum beta-lactamase-producing, aminoglycoside-resistant, and carbapenem-resistant isolates
Pharmacokinetics:
- Absorption: IM absorption: May be delayed in bedridden patient
- Protein Bound: 20%
- Half-life :3.5 hr (healthy subjects)
- Peak Plasma Time: 73.7 mcg/mL (healthy subjects); 51 mcg/mL (cUTI patients)
- Excretion: Primarily excreted by the kidneys
Contraindications
Patients with known hypersensitivity to any aminoglycoside
Adverse Reactions/Side Effects
- CV: hypertension, hypotension
- EENT: ototoxicity (vestibular and cochlear)
- GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), diarrhea, nausea, vomiting
- GU: nephrotoxicity
- Neuro: headache
- Misc: HYPERSENSITIVITY REACTIONS (including anaphylaxis)
Cautions
- Also see Black Box Warnings
- Nephrotoxicity reported; most serum creatinine increases were above 1 mg/dL above baseline and reversible.
- Ototoxicity may occur.
- Aminoglycosides have been associated with exacerbation of muscle weakness in patients with underlying neuromuscular disorders or delayed recovery of neuromuscular function in patients receiving concomitant neuromuscular blocking agents.
- Fetal harm may occur when administered to a pregnant woman (see Pregnancy)
- Serious and occasionally fatal hypersensitivity (anaphylactic) reactions reported in patients receiving aminoglycoside antibacterial drugs; discontinue treatment if an allergic reaction occurs
- Prescribing a drug in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria
Assessment
- Assess for infection (vital signs, urine, WBC) at beginning of and during therapy.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dysfunction is associated with persistently elevated peak plazomicin levels. Discontinue plazomicin if tinnitus or subjective hearing loss occurs.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.
- Monitor intake and output and daily weight to assess hydration status and renal function.
- Assess for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea).
- Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritus, laryngeal edema, wheezing) during therapy.
Patient/Family Teaching
- Explain purpose of plazomicin to patient. Emphasize importance of daily labs to prevent side effects.
- Advise patient of the importance of drinking plenty of liquids.
- Advise patient to notify health care professional immediately if signs and symptoms of hypersensitivity reaction (rash, hives, itching, swelling of lips, difficulty breathing) or if diarrhea, abdominal cramping, fever, or bloody stools occur. Instruct patient not to treat with antidiarrheals without consulting health care professional.
- Advise patient to notify health care professional if changes in hearing or balance or if new onset or changes in preexisting buzzing or roaring in ears occur, even if they occur after the completion of therapy.
- Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools).
- Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during therapy. Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
7.Paromomycin
| Paromomycin |
| Availability Capsule 250mg |
| Indications and dosages Intestinal Amebiasis (E. Histolytica) 25-35 mg/kg/day PO divided q6hr for 5-10 days Hepatic Coma (Adjunctive) 4 g PO qDay in divided doses for 5-6 days Diantomoeba Fragilis 20-30 mg/kg/day PO divided q8hr Tapeworm (T. saginata/T. solium/D. latum/D. caninum) 11 mg/kg PO divided q15min for 4 doses Dwarf Tapeworm 45 mg/kg/dose PO qDay for 5-7 days |
Mechanism of Action
Aminoglycoside; interferes with bacterial protein synthesis by binding to 30S ribosomal subunits; has antibacterial against pathogenic organisms in the GI tract
Pharmacokinetics
Absorption: Poor
Excretion: Feces (100% as unchanged drug)
Contraindications
Hypersensitivity, intestinal obstruction
Adverse Reactions/Side Effects
- GI: abdominal cramps, diarrhea, nausea, vomiting.
- Misc: hypersensitivity reactions.
Assessment
Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Patient/Family Teaching
Instruct patient and family/caregivers to report severe or prolonged GI problems including diarrhea, nausea, vomiting, and abdominal cramps.
Cautiously in:
Renal impairment; Ulcerative bowel lesions; Pregnancy, lactation, infants, and neonates (safety not established).
Route/Dosage
Intestinal Amebiasis
PO (Adults and Children): 8.33–11.67 mg/kg tid with meals for 5–10 days.
Hepatic Coma
PO (Adults): 4 g/day in 2–4 divided doses for 5–6 days.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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