Comparison of Netilmicin and Amikacin in Treatment of Complicated Urinary Tract Infections

Abstract

Netilmicin and amikacin, two recently developed aminoglycosides, were compared in a prospective, randomized study of 57 male patients with complicated urinary tract infections. Both drugs were administered intramuscularly every 12 h for 7 to 10 days, netilmicin at 2 mg/kg and amikacin at 7.5 mg/kg. The two groups were comparable as to infecting bacteria and underlying pathology of the urinary tract. No patients had indwelling catheters. All microorganisms isolated were sensitive to both antibiotics. A total of 69% of the patients treated with netilmicin and 57% of the patients treated with amikacin were cured of the infection, as defined by a negative culture at 7 days after discontinuation of treatment. No major side effects were recorded, and no significant changes were noted in parameters of renal function. Of the patients treated with amikacin, 21% experienced temporary local pain at the injection site; no such effect was noted in the netilmicin-treated group. Therefore, netilmicin appeared to be as effective and better tolerated than did amikacin in the treatment of complicated urinary tract infection.

Prospective comparative study of efficacy and toxicity of netilmicin and amikacin

“…However, comparable in vitro data and response to treatment suggest that these two aminoglycosides have similar efficacy with susceptible pathogens. Response rates to both drugs were similar to those noted previously (2,5,11,12,16,18,29,30). Most of the patients who had infections with gentamicin-resistant pathogens responded, but the small number of patients makes comparison between the two drugs difficult.…”

“…Initial serum levels were predictable in only a small majority of our patients, although levels were less variable than gentamicin in another study (26). Mean peak serum levels were similar to those previously reported using comparable doses (16,22,29,30), although some investigators (16,29) did not adjust initial doses for reduced creatinine clearances. Because initial levels may be unpredictable, peak and valley levels should be obtained early in netilmicin therapy, as with other aminoglycosides.…”

“…It is resistant to two of the enzymes that inactivate gentamicin (17,21) and has significantly less ototoxicity (19) and nephrotoxicity than gentamicin in experimental animals (7,13,15). In open clinical trials, it has been therapeutically effective and appears to have less cochlear toxicity than other aminoglycosides (2, 5; 11,12,16,22,29,30). In some clinical studies netilmicin has exhibited minimal nephrotoxicity (11,16), whereas in others nephrotoxicity has been appreciable (2,5,12,22,29,30).…”

“…In open clinical trials, it has been therapeutically effective and appears to have less cochlear toxicity than other aminoglycosides (2, 5; 11,12,16,22,29,30). In some clinical studies netilmicin has exhibited minimal nephrotoxicity (11,16), whereas in others nephrotoxicity has been appreciable (2,5,12,22,29,30). Amikacin is effective in therapy of patients with serious gram-negative infections, including those due to gentamicin-resistant organisms (18,19).…”

Comparison of moxalactam and gentamicin in the treatment of complicated urinary tract infections

“…In no instance was a moxalactamhydrolyzing enzyme detected. (3,8). Moreover, moxalactam cured 4 of the 10 patients infected with gentamicin-resistant, moxalactam-susceptible bacteria.…”