Aminoglycosides include-

Amikacin, Gentamicin, Kanamycin, Netlimicin, Streptomycin,Tobramycin,
 Neomycin,  Paromomycin,

Refer Amikacin

Drug interactions - summary
 

AMINOGLYCOSIDES -PARENTRAL

+ Aminoglycosides

Cephalosporins/ Enflurane/ Methoxyflurane / Vancomycin

Risk of nephrotoxicity increase above that with   aminoglycosides alone.
 Monitor patients. With cephalosporins, bacterial activity against
certain pathogens enhanced
 
Indomethicin  IV 

 In preterm infants, the use of indomethicin for closure of  patent
  ductus arteriosus resulted in aminoiglycosides accumulation in            
   one study

Loop diuretics 

Auditory appears to increase during concomittant use. Hearing
 loss of varying degrees may occur it may be irreversible.
  Monitor patients

Penicillins

Synergism of these agents is well documented: however certain
 penicillins may inactivate certain aminoglycosides. The problem
  may be greatest in vitro

Penicillin parentral  +   Aminoglycosides parentral

 Although used together for synergistic action,certain penicillins may               
 inactivate certain aminoglycosides in vitro. Do not mix in the
  same IV solution. Oral Neomysin may reduce the serum
  concentration of  oral penicillin.

Aminoglycosides +

Neuromuscular blockers,/Depolarising  

 Neuromuscular blocking effects are enhanced by aminoglycosides
  Prolonged respiratory depression  occur
     

Polypeptides antibiotics

 Concurrent use of these agents may increase the risk of respiratory
  paralysis and renal dysfunction

Pancuronium 

 Parentral/intraperitoneal administration of high doses of certain antibiotics 
 produce neuromuscular block on its own.
 
Atracurium 

These medications enhance the neuromuscular blocking action of atrcurium.
 
Vercurinium 

Parentral/intraperitoneal admininistration of  of high doses of certain antibiotics
 intensify or produce neuromuscular blockade on their own.
 Possibility of unexpected prolongation of neuromuscular block

Pipecuronium

Parentral/Peritoneal administration of high doses of cetain antibitotics
  intensify or  produce neuromuscular blockade on their own. If these or other
 consider prolongation of  neuromuscular block, a possiblity.

Colisimethate

Concurent use increase the risk of respiratory paralysis and renal
 dysfunction
 
Polymixin B 
concurrent use  increase the risk of respiratory paralysis
  and renal dysfunction

Bacitracin 
 concurrent use  increase risk  of respiratory collapse
-

Short term treatment of serious infections due to gram negative bacteria.

Aminoglycosides include-

Amikacin, Gentamicin, Kanamycin, Netlimicin, Streptomycin,Tobramycin, Neomycin, Paromomycin,

Refer Amikacin

Renal function changes- are usally reversible upon discontinuation.

AMINOGLYCOSIDES PARENTRAL

Amikacin- Arthalgia, tremor (rare)

Gentamicin- CNS- acute organic brain syndrome, depression, pseudotumor cerebri.respiratory depression

GI- decreased appetite, hypersalivation, stomatitis, weight loss

Hematologic- increased and decreased reticulocyte count, transient agranulocytosis

Hypersensitivity- generalised burning, laryngeal edema, purpura

Miscellaneous- alopecia, hypertension, joint pain, pulmonary fibrosis, splenomegaly, subcutaneous atrophy or fat necrosis (rare), transcient hepatomegaly, leg cramps, increased CSF protein, arachnoiditis or burning at injection site after intrathecal administration,

A Franconi-like syndrome with amonoaciduria and metabolic acidosis

Kanamycin- Granular casts,- malabsorption syndrome- characterized by an increase in fecal fat, decrease in serum carotene and fall in xylose absorption (prolonged therapy)

Netimicin- increased alkaline phosphatase, severepain, induratin and hematomas following injection, thrmbocytosis, prolonged PT hyperkalemia, palpitations, immature circulating WBCs,leukemoid reaction,nystagmus, a Fanconi-lke syndrome, with aminociduria and metabolic acidosis.

Streptomycin- Hypersensitivity- angioneurotic edema, exfoilative dermatitis Neurotoxic- facial circumoral or peripheral oaresthesia, muscular weakness, cytopenia, serum sickness, toxic epidermal necrolysis

Tobramycin- Cylindruria, delirium, leukocytosis

AMINOGLYCOSIDES ORAL

Most common- nausea and diarrhea. The- malabsorption syndrome- characterized by increased fecal fat, decreased serum carotene, and fall in xylose absorption has occurted with prolonged therapy.

Pregnancy.

Known hypersen to drug.

Disease affecting neuromuscular system like myasthenia gravis.

AMINOGLYCOSIDES PARENTRAL

Special precautions:

Renal impairment. Overgrowth of non-susceptible organisms on prolonged use. Use adequate hydration.

Intrathecal gentamicin- use of excessive doses of intrathecal gentamicin has produced neuromuscular disturbances ( eg. ataxia, paresis, incontinence)

Cross-allerginicity- among the aminoglycosides has been demonstrated and depends largely on inactivation by bacterial enzymes

Monitoring- collect urine specimens for examination during therapy. Monitor peak and trough serum concentrations periodically to assure adequate levels and to avoid potentially toxic levels. Also monitor serum calcium, magnesium and sodium.

Syphilis- in the treatment of sexually transmitted disease, if concomittant syphilis is suspected, perform darkfield examinatin before treatment is started. Perform monthly serological tests for at least 4 months.

Topical use- aminoglycosdides are quickly and almost toatally absorbed when applied topically in association with surgical procedures, except to the urinary bladder. Irreversible deafness , renal failure and death due to neuromuscular blockade have ocurred following irrigation of both small and large surgical fields with an amionoiglycoside preparation. Consider potential toxicity.

Superinfection- use of antibiotics especially for prolonged or repeated therapy may result in bacterial or fungal overgrowth of nonsuseotible organisms. Such overgrowth may lead to a secondary infection. Taske appropiate measures if this occurs.

Warnings

Toxicity- aminoglycosides are associated with significant nephrotoxicity or ototoxicity. Toxicitymay develop with conventional doses, particularly in patients with prerenal azotemia or impaired renal function.

Ototoxicity- neurotoxicity , manifested as both auditory (cohlear) and vestibular or otoxicity, can occur with any of these agents.

Burn patients- in persons with excessive burns, altered pharmacokinetics may result in reduced serum concentrations of aminoglycosides. In such patients measurements of serum concentration is especialy important for dosage determination.

Hypomagnesemia- may occur more in patients whose oral diet is restricted or who are eating poorly.

Neuromuscular blockade- neurotoxicity can occur after intrapleural and interperitoneal installatin of large doses of an aminoglycoside,however, the reaction has followed IV ,IM and oral administration.

Nephrotoxicity- can occur. Risk factors include elderly, patients with a history of renal impairment who are treated for longer periods or with higher doses than recommended.

Hydration:

These drugs reach high concentrations in th renal system, keep patients well hydratedto minimise chemical rritation of tubules. Well hydrated patients with normal renal function have low risk of nephrotoxic reactions if recommended dosage is not ecceeded.

Elderly- may have reduced renal funtion that is not evident in the results of routine screening tests. Monitoring of renal function and drug levels during treatament is particularly important in such patients.

Pregnancy- If these drugs are used during pregnancy or if the patients become pregnant while taking these drugs, appraise her of the potential hazards to the fetus.

Lactation- decide whetherto discontunue the drug or discontinue nursing taking into consideration the importance of the drug to the mother.

Children- use with caution in premature infants and neonates because of their renal immunity and the resulting prolongation of serum half-life of these drugs.

AMINOGLYCOSIDES- ORAL

Warnings-

Increased absorption- althoughnegligib;e amounts are absorbed through intact mucosa consider the possibility of increased absorption from ulcerated or denuded areas. Nephrotoxicity/Ototoxicity- because ofreported case ofdeafness and potential nephrotoxic efects closely observe patients

Pregnancy- safety for use during prtegnancy not established

Lactation- Decide wheher to discontinue nursing or to discontinue the drug taking into account the importance of the drug to the mother.

Children- Safety and efficacy or oral neomycin in patients < 18 years of age have not been established

Indications:

Short term treatment of serious infections due to gram negative bacteria.

Dosage:

Monitor patients with renal status

. Evidence of impairment in renal vestibular or auditory function requires drug discontinuation or dosage adjustment. Use patients ideal body weight for dosage calculations.

Adults.children and older infants- Administer IM or IV,15mg/kg/day divided into 2 or 3 equal doses at equally divided intervals .

Treatment of heavier patients should not exceed 1.5g/day. In uncomplicated UTI, use 250 mg twice daily. Neonates: Loading dose of 10mg/kg is recommended,followed by 7.5mg/kg every 12hours.

Duration

 The usual duration of treatment is 7 to 10 days. Do not exceed 15mg/kg/day, if the treatment exceeds 10 days. Monitor Amikacin serum levels, renal auditory and vestibular functions daily. . Uncomplicated infections due to sensitive organisms, should respond in 24 to 46 hours. If definite clinical response does not occur within 3 to 5 days, stop therapy and reevaluate.

Overdosage- Symptoms

Nephrotoxicity, neuromuscular blockade,

Treatment

1. Establish an airway andensure oxygenation and respiratory paralysis ventilation.

2. Initiate resuscitative measures promptly, if respiratory paralysis occurs.

3. Adequately hydrate patients and carefully monitor fluid balance Ccr and plasma levels.

4. Hemodialysisis preferred because it is more efficient in reducing serum levels

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Respiratory depression- Drugs causing adverse reactions- 

1. Aminoglycosides

2. Polymixins

3. Trimethaphan

4. Opiates

5. Sedatives

6. Hynotics

Amikacin

Aminoglycosides- Information applies to the following medicines Amikacin Gentamicin Kanamycin Neomycin Netlimicin Streptomycin Tobramycin

1. Individual allergy - Tell your doctor, if have ever had any unusual or allergic reactions to any aminoglycosides. Also tell your doctor if you are allergic to any other substances, such as foods, sulfites or other preservatives.

2. Pregnancy - Studies on most of the aminoglycosides have not been done in pregnant women. However, this medicine may be required in serious diseases. Be sure you have discussed this with your doctor.

3. Breast feeding - Aminoglycosides pass into breast milk in small amounts. To date, aminoglycosides have not been reported to cause problems in nursing babies. Consult your doctor and follow his advice.

4. Children - Children are especially sensitive to the effects of aminoglycosides. Damage to hearing, sense of balance and kidneys is more likely to ocur in premature infants and neonates. Follow the advice of your doctor.

5. Other medicines - Certain medicines should not be used together at all. When you are receiving aminoglycosides, it is important for your doctor to know if you are taking any other medicines - Aminoglycosides, used for skin or mucous membrane and injection at the same time.

6. Other medical problems - Presence of other medical problems may affect the use of aminoglycosides. Make sure that you tell your doctor if you have any other medical problems eg. Kidney disease, Loss of hearing, Myasthena gravis, Parkinsons disease.

7. Amnioglycosides must be given for the full time of treatment.. Complete the full course of treatment. Do not stop the medicine, even if you begin to feel better.

8. Dose - The dose of aminoglycosides wil be different for different patients. Follow the instructions of your doctor.

9. Side effects - Check with your doctor, if any side effects occur eg. loss of hearing, clumsiness or unsteadiness, increased frequency of urination or amount of urine, increased thrist, loss of appetite, nausea, vomitting, numbness, tingling, burning of face or mouth, muscle twitching, convulsions, ringing or buzzing or feeling of fullness in the ears.

Reports Not available

AMINOGLYCOSIDES -PARENTRAL

Pregnancy:

Aminoglycosides can cause fetal harm when given to pregnant women. These agents cross the placenta.

Lactation:

Small amounts are excreted in breast milk. Decide whether to continue nursing or discontinue the drug, taking into account the importance of the eug to the mother. Children- Use with caution in premature infants and neonates because of their renal immunity and the resulting prolongation of serum half-life of these drugs

AMINOGLYCOSIDES- ORAL

Pregnancy

Safety for use during prtegnancy not established

Lactation

Decide wheher to discontinue nursing or to discontinue the drug taking into account the importance of the drug to the mother.

Children- Safety and efficacy or oral neomycin in patients < 18 years of age have not been established