Acute infections caused by susceptible strains of Pseudomonas aeruginosa eg, UTI, infections of the meninges & blood stream. Infections caused by H. influenzae specifically meningeal infections (intrathecal route only), E. coli specifically UTI, Aerobacter aerogenes & Klebsiella pneumoniae specifically bacteremia, when less potentially toxic drugs are ineffective or contraindicated.
Dosage/Direction for Use
IVAdult & childn 15,000-25,000 u/kg/day every 12 hr. Infant Up to 40,000 u/kg/day. Kidney impairment Reduce from 15,000 u/kg downward every 12 hr. Total daily dose: Not >25,000 u/kg/day. IMAdult & childn 25,000-30,000 u/kg/day divided at 4-6 hr intervals. Infant Up to 40,000 u/kg/day. IntrathecalAdult & childn >2 yr 50,000 u once daily for 3-4 days then 50,000 u once every other day for at least 2 wk after cultures of CSF are -ve & sugar content returned to normal. Childn <2 yr 20,000 u once daily for 3-4 days or 25,000 u once every other day. Continue 25,000 u once every other day for at least 2 wk after cultures of CSF are -ve & sugar content returned to normal.
Contraindications
Hypersensitivity.
Special Precautions
Discontinue if Clostridium difficile-associated diarrhea is suspected or confirmed & paralysis appear. Patients w/ nephrotoxicity & renal impairment. Require baseline renal function & blood levels prior to therapy w/ frequent monitoring. Overgrowth of nonsusceptible organisms. Avoid concurrent use of curariform muscle relaxant & other neurotoxic drugs (ether, tubocurarine, succinylcholine, gallamine, decamethonium & Na citrate) &/or nephrotoxic drugs (bacitracin, streptomycin, neomycin, kanamycin, gentamycin, tobramycin, amikacin, cephaloridine, paromomycin, viomycin & colistin. Administer IM or intrathecal in hospitalize patients only. Pregnancy.
Adverse Reactions
Albuminuria, cylindruria, azotemia, rising serum drug levels w/o increasing dosage; facial flushing, dizziness progressing to ataxia, drowsiness, peripheral paresthesias (circumoral & stocking-glove); signs of meningeal irritation (intrathecal administration). Drug fever, urticarial rash; pain (severe) at IM & thrombophlebitis at IV inj site.
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