1. 4 mg/kg/dose 24-hourly
   IV infusion by syringe pump over 30 minutes
   The dose will be adjusted according to therapeutic drug monitoring protocol below.

May be given IM if IV route not possible

Indications

1. Empirical therapy for those VLBW infants with risk factors for perinatal sepsis after first week of life.
2. Suspected/proven neonatal sepsis (pneumonia, septicaemia, urinary tract infections, CNS infections, skin, bone and soft tissue infections).

Contraindications

1. Hypersensitivity to netilmicin/other aminoglycosides.

Precautions

1. Use in treatment of minor infections.
2. Impaired renal function, high dosage or prolonged therapy, increases the risk of nephrotoxicity and ototoxicity ⁴. Evidence of nephrotoxicity or ototoxicity requires dose adjustment or discontinuation of netilmicin.

Drug Interactions

+ potential neurotoxic/nephrotoxic drugs eg: amphotericin, acyclovir, other aminoglycosides = increased risk of toxicity ⁴.
+ furosemide = increased risk of ototoxicity ⁴.
+ cephalosporins = possible increase in nephrotoxicity ⁴.

Clinical Pharmacology

Semisynthetic, water-soluble aminoglycoside antibiotic which probably acts by inhibiting bacterial protein synthesis in susceptible organisms.⁴ Active against a wide variety of pathogenic bacteria including Escherichia coli, Enterobacter, Pseudomonas aeruginosa, Proteus spp, Serratia spp, Staphylococcus spp (including penicillin and methicillin resistant strains). Distributes into extracellular fluid. Does not penetrate the CSF to any significant extent. Low binding to human plasma protein. Eliminated mainly by glomerular filtration.

Possible Adverse Effects

1. Venous irritation, soft tissue injury at IV injection site.
2. Pain, soft tissue injury at IM injection site.
3. Nephrotoxicity. More likely to occur with renal impairment, prolonged therapy and/or high doses ⁴.
4. Ototoxicity. Incidence is low for netilmicin compared with other aminoglycosides, and is more likely to occur with renal impairment, prolonged therapy and/or high doses ⁴.
5. Rarely: tachycardia, hypotension, rash, fever, vomiting and diarrhoea ⁴.
6. A Fanconi-like syndrome, with aminoaciduria and metabolic acidosis, has been reported in some adults and children treated with netilmicin ⁴.

Special Considerations

1. Therapeutic Drug Monitoring:
   1. Obtain trough and peak serum levels on 2^nd dose and every 3-4 days thereafter if dose unchanged.
   2. If concerns about renal function or immaturity of baby, wait for trough level before administering 2^nd dose and performing peak levels - 36-hourly dosing may be appropriate for some babies.
   3. Trough level immediately prior to the next dose should be <2 mg/L. Desired serum peak level 30 minutes after completion of drug infusion 5-8 mg/L.
   4. Repeat trough and peak levels if dose changed - the peak level should be performed after the next dose if the dose has been increased to ensure an adequate level.
2. May be used in combination with other antibiotics if infused separately. Synergistic effect against several organisms when used with penicillins.
3. Patients should be well hydrated during treatment ⁴.
4. The proprietary preparation contains benzyl alcohol which has been associated with the "gasping syndrome". See "Description".
5. Abnormal laboratory results may occur: increase in blood sugar, alkaline phosphatase, AST, ALT, bilirubin, potassium ⁴. Decrease in haemoglobin ⁴.