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Amikacin in obstetric, gynecologic, and neonatal infections: laboratory and clinical studies
Abstract:
Based on the proportion of resistant, moderately sensitive, and sensitive strains, the descending order of activity of amikacin against clinical isolates of urinary pathogens was Salmonella, Klebsiella, Enterobacter, Escherichia coli, Staphylococcus aureus, Citrobacter, Proteus species, and Pseudomonas aeruginosa. However, amikacin was the most active of the antibiotics tested (including gentamicin and tobramycin) against 100 strains of P. aeruginosa. The calculated half-life of amikacin was substantially longer in patients with compromised renal function than in normal subjects. Immaturity of renal function, characteristic of the newborn, similarly slowed the rate of excretion of amikacin. The cure rate (complete clinical remission and eradication of the pathogen) was 91% in 22 patients with urinary tract infection (including 16 with chronic pyelonephritis) treated with 500 mg of amikacin every 8 or 12 hr for eight to 17 days. After single injections of 7.5 mg/kg 2-3 hr before delivery, appreciable amounts of the drug were recovered from the cord blood. No local or systemic intolerance or laboratory abnormalities were observed in a total of 42 patients (including eight infants) treated for a maximum of two weeks. No ototoxicity was demonstrable in any of the 12 patients subjected to audiometry; nystagmography revealed slight vestibular dysfunction in two elderly patients.
Insights
Amikacin demonstrates significant activity against urinary pathogens, particularly Pseudomonas aeruginosa. It shows a high cure rate for urinary tract infections and is well-tolerated, though excretion is slower in patients with impaired renal function.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Urinary tract infections (UTIs) are common, often caused by Gram-negative bacteria.
- Antibiotic resistance necessitates evaluation of existing and novel therapeutic agents.
- Amikacin is an aminoglycoside antibiotic with broad-spectrum activity.
Purpose of the Study:
- To evaluate the in vitro activity of amikacin against clinical urinary isolates.
- To assess the efficacy and safety of amikacin in treating UTIs.
- To investigate amikacin pharmacokinetics in patients with renal dysfunction and in newborns.
Main Methods:
- In vitro susceptibility testing of amikacin, gentamicin, and tobramycin against clinical urinary pathogens.
- Clinical trial evaluating amikacin treatment for UTIs.
- Pharmacokinetic analysis of amikacin in patients with varying renal function and in neonates.
- Safety assessment including audiometry and nystagmography.
Main Results:
- Amikacin exhibited activity against Salmonella, Klebsiella, Enterobacter, Escherichia coli, Staphylococcus aureus, Citrobacter, Proteus, and Pseudomonas aeruginosa.
- Amikacin was the most active agent against Pseudomonas aeruginosa among tested antibiotics.
- A 91% cure rate was observed in patients treated for UTIs.
- Amikacin half-life was prolonged in patients with compromised renal function and in newborns.
- No significant adverse effects or laboratory abnormalities were noted; minimal vestibular dysfunction in elderly patients.
Conclusions:
- Amikacin is effective against a range of urinary pathogens, including P. aeruginosa.
- Amikacin offers a high cure rate for UTIs with a favorable safety profile.
- Dosage adjustments are necessary for patients with impaired renal function and neonates due to altered excretion rates.