NETROMYCIN

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NETROMYCIN (NETROMYCIN).

How it works

Netromycin is an aminoglycoside antibiotic that binds to the 30S ribosomal subunit, causing misreading of mRNA and inhibition of protein synthesis in bacteria.

What the body does with it

Metabolism	Netromycin is not metabolized; it is excreted unchanged primarily by glomerular filtration.
Excretion	Renal excretion of unchanged drug accounts for 80-90% of elimination via glomerular filtration; biliary/fecal elimination is minimal (<5%).
Half-life	Terminal elimination half-life is 2-3 hours in adults with normal renal function, but may extend to 24-48 hours in patients with impaired renal function.
Protein binding	0-30% bound to plasma proteins (primarily albumin).
Volume of Distribution	0.2-0.3 L/kg, indicating distribution primarily in extracellular fluid.
Bioavailability	IM: nearly 100% (complete absorption).
Onset of Action	IM: 30-60 minutes; IV: rapid (within minutes).
Duration of Action	Approximately 8-12 hours after a dose, but prolonged in renal impairment.

Classification & Brands

Action Class

Aminoglycosides

Brand Substitutes

Netilmycin 300mg Injection, Netsafe 300mg Injection, Netilcin 300mg Injection, Netromax 300mg Injection, Netspan 300mg Injection, Internet 50mg Injection, Ntn 50mg Injection, Netilmac 50mg Injection, Netjara 50 Injection, Netmicin 50mg Injection, Netyl 10mg Injection, Netsafe 10mg Injection, Ntn 10mg Injection, Netilmac 10mg Injection, Netspan 10mg Injection, Netmicin 100mg Injection, Netcln 100mg Injection, Internet 100mg Injection, Neticin 200mg Injection, Netilcin 200mg Injection, Netspan 200mg Injection, Ntn 200mg Injection, Netromax 200mg Injection

Dosing & administration

4-6 mg/kg IV once daily for serious infections; 1.5-2 mg/kg IV every 8 hours for gram-negative infections. Administered as intravenous infusion over 30-60 minutes.

Dosage form	INJECTABLE
Renal impairment	CrCl >50 mL/min: standard dosing; CrCl 20-50 mL/min: 2-3 mg/kg every 12-24 hours; CrCl 10-20 mL/min: 2-3 mg/kg every 24-48 hours; CrCl <10 mL/min: 2-3 mg/kg every 48-72 hours. Monitor drug levels.
Liver impairment	No specific dosage adjustment recommended for hepatic impairment. Use caution in severe liver disease due to decreased clearance.
Pediatric use	Neonates: 2.5 mg/kg IV every 12-24 hours based on gestational age; Infants and children: 2-2.5 mg/kg IV every 8 hours or 4-6 mg/kg IV once daily. Adjust based on renal function and therapeutic drug monitoring.
Geriatric use	Consider renal function, usually start with lower dose (e.g., 3-4 mg/kg once daily) and adjust based on CrCl. Monitor serum levels and renal function closely.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for NETROMYCIN (NETROMYCIN).

Breastfeeding	Excreted in breast milk in low concentrations; M/P ratio not established. Risk of infant gut flora alteration and potential ototoxicity. Weigh benefits against risks; consider temporary cessation of breastfeeding.
Teratogenic Risk	Pregnancy category D. First trimester: No adequate human studies; animal studies show fetal harm. Second and third trimesters: Potential for fetal ototoxicity and nephrotoxicity; known to cross placenta. Avoid unless no safer alternative.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Aminoglycosides can cause nephrotoxicity and ototoxicity, especially in patients with impaired renal function, elderly patients, those receiving high doses or prolonged therapy, or concomitant use of other nephrotoxic/ototoxic drugs. Neuromuscular blockade and respiratory paralysis have been reported, particularly following rapid intravenous administration or in patients with neuromuscular disorders. Use during pregnancy may cause fetal harm.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to netromycin or other aminoglycosides; concurrent use of other nephrotoxic or ototoxic drugs (relative); myasthenia gravis (relative due to neuromuscular blockade risk).

Clinical Precautions

Precautions

Monitor renal function and drug levels (peak and trough) to avoid toxicity; adjust dose in renal impairment. Assess hearing and vestibular function before and during therapy. Use with caution in premature infants, neonates, elderly, and patients with pre-existing renal, auditory, or neuromuscular conditions. Avoid concurrent use of potent diuretics, other aminoglycosides, or nephrotoxic/ototoxic drugs. Neuromuscular blockade risk: use caution in patients with myasthenia gravis or parkinsonism.

Clinical Tips & Counseling

Drug interactions

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NETROMYCIN

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NETROMYCIN (NETROMYCIN).

How it works

Netromycin is an aminoglycoside antibiotic that binds to the 30S ribosomal subunit, causing misreading of mRNA and inhibition of protein synthesis in bacteria.

What the body does with it

Metabolism	Netromycin is not metabolized; it is excreted unchanged primarily by glomerular filtration.
Excretion	Renal excretion of unchanged drug accounts for 80-90% of elimination via glomerular filtration; biliary/fecal elimination is minimal (<5%).
Half-life	Terminal elimination half-life is 2-3 hours in adults with normal renal function, but may extend to 24-48 hours in patients with impaired renal function.
Protein binding	0-30% bound to plasma proteins (primarily albumin).
Volume of Distribution	0.2-0.3 L/kg, indicating distribution primarily in extracellular fluid.
Bioavailability	IM: nearly 100% (complete absorption).
Onset of Action	IM: 30-60 minutes; IV: rapid (within minutes).
Duration of Action	Approximately 8-12 hours after a dose, but prolonged in renal impairment.

Classification & Brands

Action Class

Aminoglycosides

Brand Substitutes

Dosing & administration

4-6 mg/kg IV once daily for serious infections; 1.5-2 mg/kg IV every 8 hours for gram-negative infections. Administered as intravenous infusion over 30-60 minutes.

Dosage form	INJECTABLE
Renal impairment	CrCl >50 mL/min: standard dosing; CrCl 20-50 mL/min: 2-3 mg/kg every 12-24 hours; CrCl 10-20 mL/min: 2-3 mg/kg every 24-48 hours; CrCl <10 mL/min: 2-3 mg/kg every 48-72 hours. Monitor drug levels.
Liver impairment	No specific dosage adjustment recommended for hepatic impairment. Use caution in severe liver disease due to decreased clearance.
Pediatric use	Neonates: 2.5 mg/kg IV every 12-24 hours based on gestational age; Infants and children: 2-2.5 mg/kg IV every 8 hours or 4-6 mg/kg IV once daily. Adjust based on renal function and therapeutic drug monitoring.
Geriatric use	Consider renal function, usually start with lower dose (e.g., 3-4 mg/kg once daily) and adjust based on CrCl. Monitor serum levels and renal function closely.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for NETROMYCIN (NETROMYCIN).

Breastfeeding	Excreted in breast milk in low concentrations; M/P ratio not established. Risk of infant gut flora alteration and potential ototoxicity. Weigh benefits against risks; consider temporary cessation of breastfeeding.
Teratogenic Risk	Pregnancy category D. First trimester: No adequate human studies; animal studies show fetal harm. Second and third trimesters: Potential for fetal ototoxicity and nephrotoxicity; known to cross placenta. Avoid unless no safer alternative.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to netromycin or other aminoglycosides; concurrent use of other nephrotoxic or ototoxic drugs (relative); myasthenia gravis (relative due to neuromuscular blockade risk).