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Patients with normal renal function: Adults: 4.0 - 6.0 mg/kg/day given in three equal doses every 8 hours, 2 equal doses every 12 hours or once daily.
For adults weighing 40 - 50 kg, a dose of 100 mg given every 12 hours or 200 mg once daily.
For adults weighing 50 - 90 kg, a dose of 150 mg given every 12 hours or 100 mg every 8 hours or 300 mg once daily.
For patients with life-threatening infections, dosages up to 7.5 mg/kg/day may be administered in three equal doses every 8 hours. This dosage should be reduce to 6 mg/kg/day or less as soon as clinically indicated, usually within 48 hours.
Children: 6.0 - 7.5 mg/kg/day (2.0 to 2.5 mg/kg administered every 8 hours)
Duration: The usual duration of treatment for all patients is 7 - 14 days. In complicated infections, a longer course of therapy may be necessary. Although prolonged courses of netilmicin have been well tolerated, it is important that patients treated beyond the usual time period be monitored carefully for changes in renal, auditory and vestibular function. Dosage should be reduced if clinically indicated.
Measure serum concentrations: Generally, to measure peak levels, draw a serum sample about 30 minutes after IV infusion or 1 hour after an IM dose. For trough levels, obtain serum samples at 8 hours or just prior to the next dose. Toxic peak serum level and trough serum level of netilmicin are higher than 16 and 4 mcg/mL, consecutively.
Generally, desirable peak and trough concentrations range from 6 to 10 and 0.5 to 2 mcg/mL, respectively.
Deteriorating renal function may require a greater reduction in dosage than that specified in the guidelines given as follows for patients with stable renal impairment.
The initial or loading dose is the same as that for patient with normal renal function. Three suggested methods to adjust the total daily dosage for the degree of renal impairment are: 1) Divided the suggested suggested dosage value for patients with normal renal function by serum creatinine level to obtain the adjusted size of each dose.
2) Determine the adjusted daily dose of netilmicin as the equation as follows. (See Equation 1.)
Click on icon to see table/diagram/image3) Alternatively, use the following graph to obtain the percentage of the dose selected; administer at 8 hours intervals: (See figure.)
Click on icon to see table/diagram/imageCcr can be estimated from serum creatinine levels by the following formula: (See Equation 2.)
Click on icon to see table/diagram/imageThe adjusted total daily dose may be administered as one dose at 24 hours intervals. Or as 2 or 3 equally divided doses at 12 hours or 8 hours intervals, respectively. Generally each interval dose should not exceed 3.25 mg/kg.
NELIN injection is physically compatible with the following parenteral solution, such as Sterile water for injection; 5% Dextrose in water; 5% Dextrose and 0.9% Sodium chloride injection; Ringer's injection; Normal Saline; 10% Dextrose in water; Lactated ringer's injection; Lactated ringer's injection with 5% Dextrose.
IV administration: In adults, single dose may be diluted in 50 to 200 mL of one.of the parenteral solutions as listed. In infants and children, the volume of diluent should be less, according to the fluid requirements of the patient. The solution must be infused over a period of ½ - 2 hours.
The intravenous administration of NELIN is useful for treating patients with septicemia or shock. It may also be the preferred route of administration for some patients with congestive heart failure, hematologic disorders, severe bums, or those with reduced muscle mass.
Hemodialysis: In adults with renal failure undergoing hemodialysis, the amount of netilmicin removed from the blood may vary depending upon several factors, including the dialysis method and equipment used. The dose of 2 mg/kg at the end of each dialysis period is recommended until the results of tests measuring serum levels become available. Adjust dosage appropriately based on these tests.
