Paromomycin
Paromomycin is an oral aminoglycoside antibiotic primarily utilized in veterinary medicine for its antiparasitic properties, specifically against **Cryptosporidium spp.** and **Leishmania spp.** Because it is structurally related to neomycin, it remains largely unabsorbed in the gastrointestinal tract when the mucosa is intact, allowing it to act locally on enteric pathogens. > **Clinical Pearl:** While effective for enteric protozoa, its use in cats is highly controversial due to reports of severe systemic toxicity (including acute kidney injury, ototoxicity, and blindness) even without obvious GI ulceration. Many clinicians prefer alternative therapies like azithromycin for felines.
กลไกการออกฤทธิ์: Paromomycin binds to the **30S ribosomal subunit** of susceptible organisms → causes misreading of mRNA → inhibits protein synthesis, leading to cell death. In protozoa such as *Leishmania*, it is believed to target the mitochondria and ribosomes, disrupting cellular respiration and protein synthesis.
ขนาดยาตามชนิดสัตว์
- Treatment of cryptosporidiosis in Camelids (crias) · 50 mg/kg · PO · once per day (assumed) · 5-10 days · Dosing interval not specified in original source, assumed once per day by Plumb.
- Treatment of cryptosporidiosis · 125-165 mg/kg · PO · twice daily · 5 days · Consider using an alternate treatment first (e.g., azithromycin) or paromomycin at an initially reduced dosage level.
- Treatment of cryptosporidiosis · 150 mg/kg · PO · once a day · 5 days · Caution: nephrotoxicity.
- Treatment of cryptosporidiosis · 150 mg/kg · PO · q12-24hr · Until 1 week past clinical resolution of diarrhea · If the cat is responding to the first 7 days of therapy and toxicity has not been noted.
- Treatment of cryptosporidiosis · 125-165 mg/kg · PO · twice daily · 5 days
- Treatment of cryptosporidiosis · 150 mg/kg · PO · once a day · 5 days · Caution: nephrotoxicity.
- Treatment of cryptosporidiosis · 300-800 mg/kg · PO · q24-48h · 7-14 days or as needed
ขนาดยาเป็นข้อมูลอ้างอิงทางคลินิกสำหรับสัตวแพทย์ผู้มีใบอนุญาต โปรดตรวจสอบกับฉลากล่าสุดและผู้ป่วยแต่ละรายเสมอ
วิธีการให้ยา
ข้อห้ามใช้
- Known hypersensitivity to paromomycin
- Ileus or intestinal obstruction
- Gastrointestinal ulceration
- Presence of blood in the stool (indicates mucosal breakdown and risk of systemic absorption)
อาการไม่พึงประสงค์
- Nausea
- Vomiting
- Diarrhea
- Inappetence
- Nonsusceptible bacterial or fungal overgrowth
- Nephrotoxicity (if systemically absorbed)
- Ototoxicity (if systemically absorbed)
- Pancreatitis (if systemically absorbed)
- Blindness (reported in cats)
อันตรกิริยาระหว่างยา
- Digoxin · Paromomycin may reduce digoxin absorption
- Methotrexate · Paromomycin may reduce methotrexate absorption
การติดตาม
- Clinical efficacy (resolution of diarrhea, negative fecal tests)
- Gastrointestinal adverse effects
- Renal function (especially if used in cats or if GI ulceration is suspected)
การได้รับยาเกินขนาด
Because paromomycin is not absorbed orally, acute overdose adverse effects should be limited to **gastrointestinal distress** (nausea, vomiting, diarrhea) in patients with an intact GI system. **Chronic overdoses** or administration in patients with compromised GI mucosa may lead to severe systemic toxicity, including nephrotoxicity, ototoxicity, and pancreatitis.
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