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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pharmacokinetics, nephrotoxicity, and therapeutic efficacy of (2S-cis)-4-O-[3-amino-6-(aminomethyl)-3,4-dihydro-2H-pyran-2-yl]-2-deoxy-6-O-[3-deoxy-4-C-methyl-3-(methyl-amino)-beta-L-arabinopyranosyl]-N1-ethyl-D-streptamine sulfate (netilmicin) and tobramycin were investigated in rats. The excretion rates of tubular cells and of the urinary enzyme malic dehydrogenase served as parameter of nephrotoxicity. Both compounds were, similar to other aminoglycosides, tubulotoxic within the range of dosages used for human therapy. Netilmicin, however, produced less renal damage than did tobramycin in all dosages applied. Pharmacokinetic studies revealed lower renal concentrations of netilmicin after repetitive administration. Experimental chemotherapy of the chronic E. coli pyelonephritis in rats with both aminoglycosides resulted in a significant reduction of the renal bacterial counts. In spite of approximately identical serum concentration curves and in vitro activity, especially the low dosage of netilmicin led to more favourable therapeutic results than equal doses of tobramycin. These animal experiments suggest higher renal tolerance and efficacy of netilmicin.
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PMID:[Netilmicin and tobramycin: comparative evaluation of pharmacokinetics, nephrotoxicity, and therapeutic efficacy in animal studies (author's transl)]. 58 88

The efficacy and safety of netilmicin, 5 mg/kg of body weight once daily or 2 mg/kg thrice daily for 10 days, for the treatment of gram-negative pyelonephritis in children were compared in a prospective, randomized trial. Explicit criteria were used to define the site of infection, treatment outcome, and adverse effects. Netilmicin was given to 74 children once daily and to 70 children three times daily. At 1 week posttreatment, 73 (99%) of 74 children treated with netilmicin once daily and 70 (100%) of 70 children treated with netilmicin three times daily were cured. At 4 weeks posttreatment, no relapse was detected and the rate of reinfection was essentially identical in the two treatment groups. Peak serum netilmicin concentrations were higher in patients given the once-daily regimen, whereas a higher trough level was detected in patients given the three-times-daily regimen. Nephrotoxicity, which was defined as an increase in the serum creatinine level of greater than or equal to 0.3 mg/dl over the baseline, was rare (3%) and reversible and occurred regardless of the treatment regimen. Ototoxicity, which was assessed by pure-tone audiometry (250 to 8,000 Hz) and brain stem-evoked response (6,000 Hz), occurred in 2 of 32 children who were evaluated. In these two children, who were given the once-daily regimen, wave V was not evokable monolaterally below 25 and 40 dB normal hearing level, respectively. Thus, it may be possible to treat childhood pyelonephritis with netilmicin once daily. However, this new approach needs to be confirmed in other studies.
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PMID:Comparison of 5 milligrams of netilmicin per kilogram of body weight once daily versus 2 milligrams per kilogram thrice daily for treatment of gram-negative pyelonephritis in children. 151 Apr 46

A trial was conducted with long-term intermittent netilmicin therapy in six patients suffering from chronic pyelonephritis. Netilmicin was given in full dose for a period of 3-10 days (2-6 mg/kg/day), followed by 2 mg/kg doses once or twice weekly for 3-6 months. Individual doses were determined by computer based on the age, sex, lean body weight and serum creatinine concentrations of the patients. During the full-dose period of treatment netilmicin concentrations in serum were between 2 and 16 mg/l in serum and between 50 and 200 mg/l in urine. During intermittent treatment serum levels remained below 2 mg/l (except for 8-12 hours after dosing); in the urine concentrations were permanently in therapeutic ranges (150-4 mg/l). Renal tissue levels were simulated. Six to 12 months after long-term netilmicin treatment all patients are abacteriuric and free from symptoms. No auditory or renal toxic effects occurred.
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PMID:Long-term intermittent netilmicin therapy of chronic pyelonephritis: a pharmacokinetic and clinical study. 401 46

Aminoglycoside antibiotics are useful--despite potential toxicity--for treating urinary tract infection when other antibacterial agents have failed to eradicate bacteriuria. That this is true of the recently introduced aminoglycoside netilmicin was shown by 16 cases of tenacious and frequently recurring urinary tract infection. In contrast to previous recommendations, but relying on well known pharmacokinetic data which show prolonged urinary excretion of aminoglycosides, netilmicin was administered according to the following dosage schedule: Intramuscular injections of 3 mg/kg in cases where renal function was unimpaired, and of 2 mg/kg where it was reduced, were administered at dosage intervals of 1 to 4 days. Peak serum levels of netilmicin measured 1 hour after intramuscular injection were within the expected range of 8-14 micrograms/ml (3 mg/kg) and 6-10 micrograms/ml (2 mg/kg). As a result of the long dosage intervals the serum trough levels were usually far below 1 microgram/ml except in patients with moderate renal failure. Urinary concentrations of netilmicin, however, remained for the most part above the limit of antibacterial activity throughout the dosage intervals of 1 to 4 days. One week after the usual three weeks treatment course, urinary concentrations were still between 1 and 5 mcg/ml, and slowly decreasing amounts of the drug could be detected at least in traces up to 3 months beyond the last dose. Considering the type of urinary tract infections selected to receive netilmicin, the response to treatment was satisfactory and seemed unaffected by the long dosage intervals. Bacteriological cure was achieved in 5 of 11 infections associated with chronic pyelonephritis or analgesic nephropathy and in 4 of 5 urinary infections in patients with renal transplants. Treatment failures could be accounted for by obstructive lesions, stones, and in one transplanted patient by infection localized to her own shrunken kidneys. No instance of ototoxicity or nephrotoxicity due to netilmicin could be detected. Netilmicin administered according to the dosage schedule described can be recommended for ambulatory treatment of tenacious, recurring urinary tract infections due to gram-negative bacteria and refractory to cure by the usual oral antibiotic therapy.
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PMID:[Netilmicin in refractory urinary tract infections. Good therapeutic effect in spite of long dosage intervals]. 711 61

Netilmicin was administered to 1 case of simple acute pyelonephritis and 21 cases of complicated urinary tract infections, 22 cases in total, and the effects were evaluated clinically. Total clinical effects of netilmicin evaluated by the UTI standard for evaluation of drug effects showed 61.9% of clinical effectiveness in 21 cases, and the results are satisfactory because 11 cases out of 21 cases were catheterized. The result was examined bacteriologically; the frequency of detection of particular strains among 23 strains clinically isolated from complicated urinary tract infections was that 10 strains of P. aeruginosa (43.5%), 3 of S. marcescens (13.0%), and 3 of E. coli (13.0%), and the ratios of bacteriologically disappeared strains were 70%, 33.3% and 66.7%, respectively, and the overall disappearance ratio was 73.9%. The MIC's determined for 17 strains and disappearance of the bacteria were examined; when MIC was less than 6.25 mcg/ml, 10 strains out of 12 disappeared, that is, 83% of disappearance was obtained. When MIC was larger than 100 mcg/ml, 2 strains out of 5 disappeared, that is, 40% of disappearance was obtained. Disappeared 2 strains of bacteria were isolated from patients who were not catheterized. Neither subjective symptoms nor abnormal laboratory findings related to the drug were observed. It may be said from these findings that netilmicin is an effective drug for urinary tract infections.
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PMID:[Clinical evaluations of netilmicin in urinary tract infections]. 715 43