Polusinteticeski fast acting bactericidal antibiotic of the aminoglycoside. The mechanism of action is inhibition of normal protein synthesis sensitive microorganism to the antibiotic. Active trenbolone acetate even at low concentrations against a wide range of pathogenic bacteria including Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia spp., Citrobacter spp., Proteus spp. (indole-positive and indole-negative), including Proteus mirabilis, Proteus morganii, Proteus rettgeri , Proteus vulgaris, Pseudomonas aeruginosa and Neisseria gonorrhoeae. In vitro netilmicin also active against strains of Haemophilus influenzae, Salmonella spp., Shigella spp. and against strains nepenitsillinazoobrazuyuschih penitsillinazo- and Staphylococcus, including methicillin-resistant.
Some strains of Providencia spp., Acinetobacter spp. and Aeromonas spp. also sensitive to netilmicin. Many strains of microorganisms resistant to other aminoglycosides, such as kanamycin, gentamicin, tobramycin and sizomitsin, in vitro sensitive to netilmicin. In some cases, strains resistant to amikacin sensitive to netilmicin.
The combination of penicillin G and netilmicin possesses synergistic against most strains of Streptococcus faecalis (enterococcus), but with carbenicillin or ticarcillin – against many strains of Pseudomonas aeruginosa. The strains of Serratia, resistant to many antibiotics, sensitive to the combination with netilimitsina azlocillin, mezlocillin, cefamandole, cefotaxime or moksalaktamom.
Application netromycin recommended as initial therapy for infections caused by gram-negative organisms; for suspected infection such decision to continue therapy should be based on the results of tests to determine the sensitivity and on the basis of clinical efficacy in this patient and tolerability.
In severe infections and an unknown exciter netromycin can be administered as initial therapy in combination with antibiotics from the group of penicillins and cephalosporins to obtain test results for sensitivity determination. If you suspect an anaerobic flora in combination with netromycin should be given appropriate antibiotic therapy. After identification of the pathogen and determine its sensitivity should continue administering netromycin or other appropriate antimicrobial therapy.
Netromycin effective when used in combination with karbenetsillinom or ticarcillin for the treatment of infections caused by Pseudomonas aeruginosa; and in combination with an antibiotic of the penicillin group – for the treatment of endocarditis caused by strains of Streptococcus. In neonates with suspected sepsis or pneumonia caused by staphylococci shown the combined use of penicillins trenbolone acetate and netromycin.
The possibility of using netromycin should be considered in the treatment of serious staphylococcal infections when there are contraindications to the use of penicillins or other less toxic antibiotics and tests for determining the sensitivity of microorganisms and evaluation of clinical data indicate the possibility of the drug. Possibility of use of the drug should be considered in the treatment of mixed infections caused by susceptible strains of Staphylococcus and gram-negative microorganisms.
Treatment of infectious and inflammatory diseases caused by susceptible to malaria infections:
– septicemia (including neonatal sepsis)
– severe respiratory infections;
– kidney and urinary tract infections, including acute uncomplicated gonococcal infection in men (urethra, rectum) and female (urethra, cervix, rectum) with normal renal function;
– skin and soft tissue infections,
– infections of bones and joints;
– burns, wounds, postoperative infections ( including prophylactic treatment)
– abdominal infections (including peritonitis)
– infection of the gastrointestinal tract.
– Hypersensitivity or serious toxic reactions to netilmicin or other aminoglycosides;
– neuritis of the auditory nerve;
– severe chronic renal failure;
– Children under 3 years – only for the dosage of 100 mg / ml (due to lack of information about the safety of benzyl alcohol, available as part of this form of release).
– myasthenia gravis
– old age.
Dosing and Administration
Intravenous (w / w) or intramuscular (i / m) administration. Doses recommended for in / in / m of identical. B / administration may be particularly useful in treating patients with septicemia or under shock, as well as patients with congestive heart failure, hematological disorders with severe burns or with reduced muscle mass.
To calculate the correct dose should trenbolone acetate determine the patient’s body weight before therapy. The dosage of aminoglycosides in patients with a high body mass is calculated on the ideal body weight (ie excluding overweight subcutaneous fat).
The average duration of therapy is 7-14 days, in severe infections with complications may require a longer course of treatment.
Adults with normal renal function, the recommended dose netromycin injection with urinary tract infections or systemic infections of moderate severity 4.0-6.0 mg / kg / day, divided into 3 equal administration every 8 hours or 2 injection every 12 hours or 1 administration per day, and the dose should be adjusted depending on the severity of the infection and condition of the patient. Adult weighing 50-90 kg administered at 150 mg every 12 hours or 100 mg every 8 hours. Adult patients with more or less body weight should be calculated dose in mg / kg body weight degreased.
In severe life-threatening infections possible use of the drug at a dose of 7.5 mg / kg / day, divided into 3 injections every 8 h. The dose according to clinical situation is reduced to 6 mg / kg / day (usually 48 hours).
In gonorrhea in men and women it is recommended once in / m introduction netromycin at a dose of 300 mg. Injection (use solution with a concentration of 100 mg / ml) should be made deep in the upper outer quadrant of the gluteal muscle by half doses introducing in each buttock. For patients with more or less weight recommended dose recalculation based on the degreased body weight.
Uncomplicated urinary tract infections , particularly chronic or relapsing course and without evidence of renal failure, the drug may be administered to a / m times in one knocks at a dose rate of 3 mg / kg for 7-10 days.
Children drug administered according to the age. Infants (including premature) at the age of one week or less dose set at 6 mg / kg / day (3.0 mg / kg administered every 12 hours); Children aged 1 week to 1 year – from 7.5 to 9.0 mg / kg / day. (at 2.5-3.0 mg / kg administered every 8 hours.); children older than 1 year : from 6.0 to 7.5 mg / kg / day. (at 2.0-2.5 mg / kg administered every 8 hours.).
When combined with other antibiotics should not change the dose recommended in patients with normal or impaired renal function.
In patients with impaired renal function for correction of dosing regimen is necessary to monitor serum concentrations of netilmicin. If this is not possible, and the kidney condition is stable, for dose adjustment to focus on the most reliable indicators of creatinine clearance and creatinine in serum.
One way to correct dosing regimen is to increase the interval between injections in the medium recommended doses. For this purpose, the interval between doses (in hours) is determined by multiplying the serum creatinine level (mg / 100 ml) 8.
In patients with severe infections and impaired renal function may require more frequent administration of the antibiotic, but in a reduced dose.
After introduction average initial loading dose or approximate method for determining a reduced dose when administered once every 8 hours is the mean value to divide the dose to creatinine value in serum (see. Table. 1).
If you know the creatinine clearance (CC), the maintenance dose, administered every 8 hours, determined by the formula:
Maintenance dose trenbolone acetate observed QA / QC’s normal standard maintenance dose