ํฉ์ฐ ์๋ฏธ์นด์
์๋ฏธ์นด์ ์ ์นด๋๋ง์ด์ ์์ ์ ๋ํ ๊ฐ๋ ฅํ ๋ฐํฉ์ฑ **์๋ฏธ๋ ธ๊ธ๋ฆฌ์ฝ์ฌ์ด๋๊ณ ํญ์์ **์ ๋๋ค. ์ฃผ๋ก ์ฌ๊ฐํ ๋ค์ ๋ด์ฑ(MDR) **๊ทธ๋ ์์ฑ ํธ๊ธฐ์ฑ ์ธ๊ท ๊ฐ์ผ**(์: ๋ น๋๊ท , ๋์ฅ๊ท , ํด๋ ๋ธ์์๋ผ, ํ๋กํ ์ฐ์ค)์ ์ฌ์ฉ๋ฉ๋๋ค. ๊ฒํ๋ง์ด์ ์ ๋ถํ์ฑํํ๋ ๋ง์ ํจ์์ ์ ํญ์ฑ์ด ์์ด ๊ฒํ๋ง์ด์ ๋ด์ฑ ๊ท ์ฃผ์๋ ํจ๊ณผ์ ์ธ ๊ฒฝ์ฐ๊ฐ ๋ง์ต๋๋ค. **์์ ์์ :** ์๋ฏธ๋ ธ๊ธ๋ฆฌ์ฝ์ฌ์ด๋๊ณ๋ ๋๋ ์์กด์ ์ด๊ท ํ์ฑ๊ณผ ์ ์๋ฏธํ ํญ์์ ํ ํจ๊ณผ(PAE)๋ฅผ ๋ํ๋ ๋๋ค. ๋ฐ๋ผ์ ํ๋ ์์ํ์์๋ ์ต๊ณ ๋๋๋ฅผ ๊ทน๋ํํ์ฌ ์ด๊ท ๋ ฅ์ ๋์ด๊ณ ์ต์ ๋๋๋ฅผ ๋ฎ์ถฐ ์ ๋ ์ฑ ์ํ์ ์ต์ํํ๋ **1์ผ 1ํ(๊ณ ์ฉ๋, ์ฐ์ฅ ๊ฐ๊ฒฉ) ํฌ์ฌ**๋ฅผ ๊ฐ๋ ฅํ ๊ถ์ฅํฉ๋๋ค. ์ง๊ท , ๋ฐ์ด๋ฌ์ค ๋ฐ ๋๋ถ๋ถ์ ํ๊ธฐ์ฑ ์ธ๊ท ์๋ ํจ๊ณผ๊ฐ ์์ต๋๋ค.
์์ฉ ๊ธฐ์ : Amikacin actively transports across the bacterial cell membrane via an **oxygen-dependent mechanism** (which is why it is ineffective against anaerobic bacteria). Once inside, it binds irreversibly to the **30S ribosomal subunit**. Binding to 30S subunit โ interferes with the initiation complex between mRNA and the ribosome โ causes misreading of the genetic code โ produces nonfunctional proteins โ leads to rapid bacterial cell death. **Clinical Pearl:** Its antimicrobial activity is significantly enhanced in an alkaline environment and markedly reduced in purulent, acidic, or necrotic debris.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Empiric therapy ยท 10-15 mg/kg ยท IV/IM/SC ยท Not specified ยท Route not specified, assume IV, IM or SC
- Susceptible infections ยท 15 mg/kg (route not specified) once daily (q24h). Neutropenic or immunocompromised patients may still need to be dosed q8h (dose divided). ยท Not specified ยท q24h (or q8h)
- Sepsis ยท 20 mg/kg once daily IV ยท IV ยท q24h
- Susceptible infections ยท 8-16 mg/kg IM or IV once daily ยท IM/IV ยท q24h
- Susceptible infections ยท 8-16 mg/kg/day SC, IM, IV divided q8-24h ยท SC/IM/IV ยท q8-24h
- Susceptible infections ยท 10 mg/kg IM q8h or 25 mg/kg q12h ยท IM ยท q8h or q12h
- Susceptible infections ยท 22 mg/kg/day IM divided three times daily ยท IM ยท TID
- Susceptible infections ยท 21 mg/kg IV or IM once daily (q24h) ยท IV/IM ยท q24h
- Susceptible infections (Neonatal foals) ยท 21 mg/kg IV once daily ยท IV ยท q24h
- Susceptible infections (Neonatal foals) ยท Initial dose of 25 mg/kg IV once daily ยท IV ยท q24h ยท Strongly recommend to individualize dosage based upon therapeutic drug monitoring.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to aminoglycosides
- Generally contraindicated in rabbits/hares (adversely affects GI flora balance)
์ด์๋ฐ์
- Nephrotoxicity (tubular necrosis)
- Ototoxicity (auditory and vestibular)
- Neuromuscular blockade
- Facial edema
- Injection site pain/inflammation
- Peripheral neuropathy
- Hypersensitivity reactions
์ฝ๋ฌผ ์ํธ์์ฉ
- Beta-lactam antibiotics (penicillins, cephalosporins) ยท May have synergistic effects against some bacteria; potential for physical inactivation of aminoglycosides in vitro (do not mix together) and in vivo (patients in renal failure).
- Cephalosporins ยท Potentially could cause additive nephrotoxicity (controversial, well documented only with older agents like cephaloridine and cephalothin).
- Loop or Osmotic Diuretics (e.g., furosemide, torsemide, mannitol) ยท Concurrent use may increase the nephrotoxic or ototoxic potential of the aminoglycosides.
- NSAIDs ยท May cause nephrotoxic effects; concurrent use with aminoglycosides should generally be avoided.
- Other Nephrotoxic Drugs (e.g., cisplatin, amphotericin B, polymyxin B, vancomycin) ยท Potential for increased risk for nephrotoxicity.
- Neuromuscular blocking agents & General anesthetics ยท Concomitant use could potentiate neuromuscular blockade.
๋ชจ๋ํฐ๋ง
- Efficacy (cultures, clinical signs, WBCs)
- Therapeutic drug monitoring (TDM) is highly recommended: Peak level should be at least 40 mcg/mL and the 4-hour trough sample less than 10 mcg/mL
- Renal function tests (BUN, creatinine) and urinalysis (USG, casts) pre-therapy and repeated during therapy
- Gross monitoring of vestibular or auditory toxicity
๊ณผ์ฉ๋
Should an inadvertent overdosage be administered, three treatments have been recommended: - **Hemodialysis:** Very effective in reducing serum levels but rarely a viable option for veterinary patients. - **Peritoneal dialysis:** Will reduce serum levels but is much less efficacious. - **Complexation:** Complexation of drug with either carbenicillin or ticarcillin (12-20 g/day in humans) is reportedly nearly as effective as hemodialysis.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.