Toxicity and ototoxicity

VANCOMYCIN CICLOSPORIN Risk of renal toxicity and ototoxicity Additive toxic effects Monitor renal function closely... 

Isepamicin is similar to amikacin but has better activity against strains that produce type I 6 -acetyltransferase. It can cause nephrotoxicity, vestibular toxicity, and ototoxicity. However, it is one of the less toxic of the aminoglycosides (1). The antibacterial spectrum of isepamicin includes Enterobacteriaceae and staphylococci anaerobes, Neisseriae, and streptococci are resistant (1). Isepamicin was as effective and safe as amikacin in the treatment of acute pyelonephritis in children and might prove an advantageous alternative in areas with a high incidence of resistance to other aminoglycosides (2). 

Potassium borate Lavage with 2% sodium bicarbonate solution and administer 10-50 ml of 10% sodium thiosulfate solution intravenously at the rate of 3 ml min to reduce the bromate to the less toxic bromide ion. An alternative therapy is the administration of 100-500 ml of 1% sodium thiosulfate. Patients should be observed for development of renal toxicity and ototoxicity. 

When administering aminoglycosides intravenously, dilute the medication in solution as per the package insert and infuse it over a 30- to 60-minute period. Use a smaller than normal dose for elderly patients who are at greater risk for kidney toxicity and ototoxicity. 

Gapreomycin, Viomycin, and Enviomycin. Capreomycin (Capastat, Lilly), a bacteriostatic, antimycobacterial peptide mixture isolated from Streptomjces capreolus was first reported in 1961 (106—108). This tuberactinomycin family member, shown in Table 4, was introduced into the U.S. market in 1971 where it has remained a usehil but nephrotoxic and ototoxic second-line alternative to first-line tuberculosis therapies. Because capreomycin is somewhat less toxic than viomycin (tuberoactinomycin B [32988-50-4]) C25H42N23O2Q (109,110), capreomycin has now displaced viomycin in the United States and most other markets. The stmcture of viomycin is shown in Figure 2. The related enviomycin (tuberactinomycin N [33103-22-9]), C23H43N23O2Q,... 

These dm are contraindicated in patients with known hypersensitivity to the drug or any components of the drug. Because neomycin toxicity can cause nephrotoxicity and ototoxicity, neomycin is used cautiously in patients with extensive bums or trophic ulceration when extensive absorption can occur. 

Aminoglycosides accumulate in otolymph and can cause both vestibular and auditory ototoxicity, both of which can be irreversible. Uptake is driven by the concentration gradient between blood and the otolymph this process is saturable. Sustained high concentrations in otolymph first destroy hair cells that are sensitive to high-frequency sounds. Streptomycin is more likely to cause vestibular toxicity than ototoxicity. The severity... 

Streptomycin Prevents bacterial protein synthesis by binding to the S12 ribosomal subunit (see also Chapter 45) Bactericidal activity against susceptible mycobacteria Used in tuberculosis when an injectable drug is needed or desirable and in treatment of drug-resistant strains IM, IV renal clearance (half-life 2.5 h) administered daily initially, then 2 x week Toxicity Nephrotoxicity, ototoxicity... 

It is important to monitor peak and trough plasma levels (see p. 20) of gentamicin, tobramycin, netilmicin, and amikacin to avoid concentrations that cause dose-related toxicities (Figure 31.7). [Note Peak levels are defined as those obtained 1/2 to 1 hour after infusion. Trough levels are obtained immediately before the next dose.] Patient factors, such as old age, previous exposure to aminoglycosides, gender, and liver disease, tend to predispose patients to adverse reactions. The elderly are particularly susceptible to nephrotoxicity and ototoxicity. 

At present, derivatives of platinum eompounds have found wide use in chemotherapy of malignant tumors. It should be noted that, along with their high antitumor effect, these eompounds exhibit a high toxicity. Supposedly, their eytotoxic effect and other side-effects (nephro- and ototoxicity, nausea, etc.) are associated with intensification of free-radical... 

PLATINUM COMPOUNDS AMINOGLYCOSIDES, CAPREOMYCIN, COLISTIN, STREPTOMYCIN, VANCOMYCIN t risk of renal toxicity and renal failure and of ototoxicity. The ototoxicity tends to occur when cisplatin is administered early during the course of aminoglycoside therapy Additive renal toxicity Monitor renal function prior to and during therapy, and ensure an intake of at least 2 L of fluid daily. Monitor serum potassium and magnesium and correct any deficiencies. Most side-effects of aminoglycosides are dose-related, and it is necessary to t interval between doses and 1 dose of aminoglycoside if there is impaired renal function... 

Due to the risks of serious adverse events such as nephrotoxicity and ototoxicity observed when systemic vancomycin was first used, therapeutic drug monitoring programs (TDM) for vancomycin were developed. To amehorate the risk of toxicity, clinicians have historically targeted a peak vancomycin serum concentration of 30 to 40 mg/L and a trough serum concentration of 5 to 10 mg/L. However, there is a notable lack of... 

Aminoglycosides Group toxicity aii agents in this group are nephrotoxic and ototoxic ototoxicity is worse when the patient is hyperbiiirubinemic measure serum ieveis for efficacy and toxicity peritoneai absorption increases with presence of inflammation. V increases with edema, obesity, and ascites ... 

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