Abstract
The two-compartment tissue accumulation pharmacokinetics of tobramycin and netilmicin were compared in 11 normal volunteers by using a crossover design. After each 1.0-mg/kg (body weight) dose, serum was collected for 96 h, and complete 24-h urine collections were obtained for a total of 30 days. Two months of washout were required before crossover. Concentrations in serum and urine were measured by radioimmunoassay, and concentrations in serum and urinary excretion rates were simultaneously fitted to a two-compartment pharmacokinetic model. Netilmicin exhibited significantly lower total body clearance (48 versus 90 ml/min) and longer terminal elimination half-life (161 versus 96 h) than tobramycin. As a result of these pharmacokinetic differences, the predicted tissue accumulation of netilmicin at steady state was significantly higher than that of tobramycin (P less than 0.05). Relative rates of aminoglycoside nephrotoxicity probably depend on both the differential tissue uptake (accumulation) and the concentration of the aminoglycoside which produces intracellular toxicity. Because the steady-state tissue accumulation of netilmicin is nearly 2.5 times greater than that of tobramycin, its potency in the production of intracellular toxicity needs to be that much less for the two agents to produce the same incidence of clinical nephrotoxicity.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adelman M., Evans E., Schentag J. J. Two-compartment comparison of gentamicin and tobramycin in normal volunteers. Antimicrob Agents Chemother. 1982 Nov;22(5):800–804. doi: 10.1128/aac.22.5.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bock B. V., Edelstein P. H., Meyer R. D. Prospective comparative study of efficacy and toxicity of netilmicin and amikacin. Antimicrob Agents Chemother. 1980 Feb;17(2):217–225. doi: 10.1128/aac.17.2.217. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brier M. E., Mayer P. R., Brier R. A., Visscher D., Luft F. C., Aronoff G. R. Relationship between rat renal accumulation of gentamicin, tobramycin, and netilmicin and their nephrotoxicities. Antimicrob Agents Chemother. 1985 May;27(5):812–816. doi: 10.1128/aac.27.5.812. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Buckwold F. J., Ronald A. R., Lank B., Thompson L., Fox L., Harding G. K. Clinical efficacy and toxicity of netilmicin in the treatment of gram-negative infections. Can Med Assoc J. 1979 Jan 20;120(2):161–167. [PMC free article] [PubMed] [Google Scholar]
- Chung M., Costello R., Symchowicz S. Comparison of netilmicin and gentamicin pharmacokinetics in humans. Antimicrob Agents Chemother. 1980 Feb;17(2):184–187. doi: 10.1128/aac.17.2.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Edwards D. J., Mangione A., Cumbo T. J., Schentag J. J. Predicted tissue accumulation of netilmicin in patients. Antimicrob Agents Chemother. 1981 Dec;20(6):714–717. doi: 10.1128/aac.20.6.714. [DOI] [PMC free article] [PubMed] [Google Scholar]
- French M. A., Cerra F. B., Plaut M. E., Schentag J. J. Amikacin and gentamicin accumulation pharmacokinetics and nephrotoxicity in critically ill patients. Antimicrob Agents Chemother. 1981 Jan;19(1):147–152. doi: 10.1128/aac.19.1.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Giuliano R. A., Verpooten G. A., Verbist L., Wedeen R. P., De Broe M. E. In vivo uptake kinetics of aminoglycosides in the kidney cortex of rats. J Pharmacol Exp Ther. 1986 Feb;236(2):470–475. [PubMed] [Google Scholar]
- Hottendorf G. H., Barnett D., Gordon L. L., Christensen E. F., Madissoo H. Nonparallel nephrotoxicity dose-response curves of aminoglycosides. Antimicrob Agents Chemother. 1981 Jun;19(6):1024–1028. doi: 10.1128/aac.19.6.1024. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lerner A. M., Reyes M. P., Cone L. A., Blair D. C., Jansen W., Wright G. E., Lorber R. R. Randomised, controlled trial of the comparative efficacy, auditory toxicity, and nephrotoxicity of tobramycin and netilmicin. Lancet. 1983 May 21;1(8334):1123–1126. doi: 10.1016/s0140-6736(83)92864-7. [DOI] [PubMed] [Google Scholar]
- Lipsky J. J., Lietman P. S. Aminoglycoside inhibition of a renal phosphatidylinositol phospholipase C. J Pharmacol Exp Ther. 1982 Feb;220(2):287–292. [PubMed] [Google Scholar]
- Luft F. C., Bloch R., Sloan R. S., Yum M. N., Costello R., Maxwell D. R. Comparative nephrotoxicity of aminoglycoside antibiotics in rats. J Infect Dis. 1978 Oct;138(4):541–545. doi: 10.1093/infdis/138.4.541. [DOI] [PubMed] [Google Scholar]
- Luft F. C., Yum M. N., Kleit S. A. Comparative nephrotoxicities of netilmicin and gentamicin in rats. Antimicrob Agents Chemother. 1976 Nov;10(5):845–849. doi: 10.1128/aac.10.5.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Panwalker A. P., Malow J. B., Zimelis V. M., Jackson G. G. Netilmicin: clinical efficacy, tolerance, and toxicity. Antimicrob Agents Chemother. 1978 Feb;13(2):170–176. doi: 10.1128/aac.13.2.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Parker R. A., Gilbert D. N., Houghton D. C., Porter G. A., Bennett W. M. Comparative nephrotoxicities of high-dose netilmicin and tobramycin in rats. Antimicrob Agents Chemother. 1980 Aug;18(2):346–348. doi: 10.1128/aac.18.2.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Regamey C., Gordon R. C., Kirby W. M. Comparative pharmacokinetics of tobramycin and gentamicin. Clin Pharmacol Ther. 1973 May-Jun;14(3):396–403. doi: 10.1002/cpt1973143396. [DOI] [PubMed] [Google Scholar]
- Schentag J. J., Cumbo T. J., Jusko W. J., Plaut M. E. Gentamicin tissue accumulation and nephrotoxic reactions. JAMA. 1978 Nov 3;240(19):2067–2069. [PubMed] [Google Scholar]
- Schentag J. J., Jusko W. J., Vance J. W., Cumbo T. J., Abrutyn E., DeLattre M., Gerbracht L. M. Gentamicin disposition and tissue accumulation on multiple dosing. J Pharmacokinet Biopharm. 1977 Dec;5(6):559–577. doi: 10.1007/BF01059684. [DOI] [PubMed] [Google Scholar]
- Schentag J. J., Lasezkay G., Cumbo T. J., Plaut M. E., Jusko W. J. Accumulation pharmacokinetics of tobramycin. Antimicrob Agents Chemother. 1978 Apr;13(4):649–656. doi: 10.1128/aac.13.4.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schentag J. J., Plaut M. E., Cerra F. B. Comparative nephrotoxicity of gentamicin and tobramycin: pharmacokinetic and clinical studies in 201 patients. Antimicrob Agents Chemother. 1981 May;19(5):859–866. doi: 10.1128/aac.19.5.859. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schentag J. J. Specificity of renal tubular damage criteria for aminoglycoside nephrotoxicity in critically ill patients. J Clin Pharmacol. 1983 Oct;23(10):473–483. doi: 10.1002/j.1552-4604.1983.tb01793.x. [DOI] [PubMed] [Google Scholar]
- Snydman D. R., Tally F. P., Landesman S. H., Barza M., Gorbach S. L. Netilmicin in gram-negative bacterial infections. Antimicrob Agents Chemother. 1979 Jan;15(1):50–54. doi: 10.1128/aac.15.1.50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Trestman I., Parsons J., Santoro J., Goodhart G., Kaye D. Pharmacology and efficacy of netilmicin. Antimicrob Agents Chemother. 1978 May;13(5):832–836. doi: 10.1128/aac.13.5.832. [DOI] [PMC free article] [PubMed] [Google Scholar]
