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AMINOGLYCOSIDES (Systemic)

Some commonly used brand names are:

In the U.S.—

• Amikin ¹
• Garamycin ²
• G-Mycin ²
• Jenamicin ²
• Kantrex ³
• Nebcin ⁷
• Netromycin ⁵

In Canada—

• Amikin ¹
• Garamycin ²
• Nebcin ⁷
• Netromycin ⁵

Category

• Antibacterial, antimycobacterial—Streptomycin
• Antibacterial, systemic—Amikacin; Gentamicin; Kanamycin; Netilmicin; Streptomycin; Tobramycin

Description

Aminoglycosides (a-mee-noe-GLYE-koe-sides) are used to treat serious bacterial infections. They work by killing bacteria or preventing their growth.

Aminoglycosides are given by injection to treat serious bacterial infections in many different parts of the body. In addition, some aminoglycosides may be given by irrigation (applying a solution of the medicine to the skin or mucous membranes or washing out a body cavity) or by inhalation into the lungs. Streptomycin may also be given for tuberculosis (TB). These medicines may be given with 1 or more other medicines for bacterial infections, or they may be given alone. Aminoglycosides may also be used for other conditions as determined by your doctor. However, aminoglycosides will not work for colds, flu, or other virus infections.

Aminoglycosides given by injection are usually used for serious bacterial infections for which other medicines may not work. However, aminoglycosides may also cause some serious side effects, including damage to your hearing, sense of balance, and kidneys. These side effects may be more likely to occur in elderly patients and newborn infants. You and your doctor should talk about the good these medicines may do as well as the risks of receiving them .

Aminoglycosides are to be administered only by or under the immediate supervision of your doctor. They are available in the following dosage forms:

• Inhalation
• Amikacin
  • Inhalation solution (U.S.)
• Gentamicin
  • Inhalation solution (U.S.)
• Kanamycin
  • Inhalation solution (U.S.)
• Tobramycin
  • Inhalation solution (U.S.)

• Irrigation
• Kanamycin
  • Irrigation solution (U.S.)

• Parenteral
• Amikacin
  • Injection (U.S. and Canada)
• Gentamicin
  • Injection (U.S. and Canada)
• Kanamycin
  • Injection (U.S.)
• Neomycin
  • Injection (U.S.)
• Netilmicin
  • Injection (U.S. and Canada)
• Streptomycin
  • Injection (U.S. and Canada)
• Tobramycin
  • Injection (U.S. and Canada)

Before Receiving This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For aminoglycosides, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to any of the aminoglycosides. Also tell your health care professional if you are allergic to any other substances, such as foods, sulfites, or other preservatives.

Pregnancy—Studies on most of the aminoglycosides have not been done in pregnant women. Some reports have shown that aminoglycosides, especially streptomycin and tobramycin, may cause damage to the infant"s hearing, sense of balance, and kidneys if the mother was receiving the medicine during pregnancy. However, this medicine may be needed in serious diseases or other situations that threaten the mother"s life. Be sure you have discussed this with your doctor.

Breast-feeding—Aminoglycosides pass into breast milk in small amounts. However, they are not absorbed very much when taken by mouth. To date, aminoglycosides have not been reported to cause problems in nursing babies.

Children—Children are especially sensitive to the effects of aminoglycosides. Damage to hearing, sense of balance, and kidneys is more likely to occur in premature infants and neonates.

Older adults—Elderly people are especially sensitive to the effects of aminoglycosides. Serious side effects, such as damage to hearing, sense of balance, and kidneys may occur in elderly patients.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving aminoglycosides it is especially important that your health care professional knows if you are taking any of the following:

• Aminoglycosides, used on the skin or mucous membranes and by injection at the same time; or more than one aminoglycoside at a time or
• Anti-infectives by mouth or by injection (medicine for infection) or
• Capreomycin (e.g., Capastat) or
• Carmustine (e.g., BiCNU) or
• Chloroquine (e.g., Aralen) or
• Cisplatin (e.g., Platinol) or
• Combination pain medicine containing acetaminophen and aspirin (e.g., Excedrin) or other salicylates (with large amounts taken regularly) or
• Cyclosporine (e.g., Sandimmune) or
• Deferoxamine (e.g., Desferal) (with long-term use) or
• Gold salts (medicine for arthritis) or
• Hydroxychloroquine (e.g., Plaquenil) or
• Inflammation or pain medicine, except narcotics, or
• Lithium (e.g., Lithane) or
• Methotrexate (e.g., Mexate) or
• Penicillamine (e.g., Cuprimine) or
• Plicamycin (e.g., Mithracin) or
• Quinine (e.g., Quinamm) or
• Streptozocin (e.g., Zanosar) or
• Tiopronin (e.g., Thiola)—Use of any of these medicines with aminoglycosides may increase the chance of hearing, balance, or kidney side effects.

Other medical problems—The presence of other medical problems may affect the use of the aminoglycosides. Make sure you tell your doctor if you have any other medical problems, especially:

• Kidney disease—Patients with kidney disease may have increased aminoglycoside blood levels and increased chance of side effects

• Loss of hearing and/or balance (eighth-cranial-nerve disease)—High aminoglycoside blood levels may cause hearing loss or balance disturbances

• Myasthenia gravis or
• Parkinson"s disease—Aminoglycosides may cause muscular problems, resulting in further muscle weakness

Proper Use of This Medicine

To help clear up your infection completely, aminoglycosides must be given for the full time of treatment , even if you begin to feel better after a few days. Also, this medicine works best when there is a certain amount in the blood or urine. To help keep the correct level, aminoglycosides must be given on a regular schedule.

Dosing—The dose of aminoglycosides will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of aminoglycosides. Your dose may be different if you have kidney disease. If your dose is different, do not change it unless your doctor tells you to do so.

The dose of most aminoglycosides is based on body weight and must be determined by your doctor. The medicine is injected into a muscle or vein. Depending on the aminoglycoside prescribed, doses are given at different times and for different lengths of time. These times are as follows:

• For amikacin
• For all dosage forms:
  • Adults and children: The dose is given every eight or twelve hours for seven to ten days.
  • Newborn babies: The dose is given every twelve hours for seven to ten days.
  • Premature babies: The dose is given every eighteen to twenty-four hours for seven to ten days.

• For gentamicin
• For all dosage forms:
  • Adults and children: The dose is given every eight hours for seven to ten days or more.
  • Infants: The dose is given every eight to sixteen hours for seven to ten days or more.
  • Premature and full-term newborn babies: The dose is given every twelve to twenty-four hours for seven to ten days or more.

• For kanamicin
• For all dosage forms:
  • Adults and children: The dose is given every eight or twelve hours for seven to ten days.

• For netilmicin
• For all dosage forms:
  • Adults and children: The dose is given every eight or twelve hours for seven to fourteen days.

• For streptomycin
• For all dosage forms—The dose of streptomycin is often not based on body weight and the amount given depends on the disease being treated.
  • Treatment of tuberculosis (TB) :
    • Adults: Dose is based on body weight and must be determined by your doctor. This dose is injected into a muscle. The dosing schedule will also be determined by your doctor, usually once daily or twice weekly or three times-a-week. This medicine must be given with other medicines for tuberculosis (TB).
    • Children and adolescents: Dose is based on body weight and must be determined by your doctor. This dose is injected into a muscle. The dosing schedule will also be determined by your doctor, usually once daily or twice weekly or three times-a-week. This medicine must be given with other medicines for tuberculosis (TB).
  • Treatment of bacterial infections :
    • Adults: 250 to 500 milligrams of streptomycin is injected into a muscle every six hours; or 500 milligrams to 1 gram of streptomycin is injected into a muscle every twelve hours.
    • Children and adolescents: Dose is based on body weight and must be determined by your doctor. This dose is injected into a muscle every six to twelve hours.

• For tobramycin
• For all dosage forms:
  • Adults and adolescents: The dose is given every six to eight hours for seven to ten days or more.
  • Older infants and children: The dose is given every six to sixteen hours.
  • Premature and full-term newborn babies: The dose is given every twelve to twenty-four hours.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your health care professional immediately if any of the following side effects occur:

For up to several weeks after you stop receiving this medicine, it may still cause some side effects that need medical attention. Check with your doctor if you notice any of the following side effects or if they get worse:

Any loss of hearing; clumsiness or unsteadiness; dizziness; greatly increased or decreased frequency of urination or amount of urine; increased thirst; loss of appetite; nausea or vomiting; ringing or buzzing or a feeling of fullness in the ears

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 09/11/2002

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