paromomycin


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Related to paromomycin: metronidazole, Paromomycin sulfate

paromomycin

 [par´ah-mo-mi″sin]
a broad-spectrum antibiotic derived from Streptomyces rimosus var. paromomycinus; the sulfate salt is used as an antiamebic.

paromomycin

(par-oh-moemye-sin)

Classification

Therapeutic: amebicide
Pregnancy Category: C

Indications

Treatment of acute and chronic intestinal amebiasis.Management of hepatic coma as adjunctive therapy.

Action

Inhibits protein synthesis in bacteria at level of 30S ribosome.

Therapeutic effects

Resolution of amebic infections.
Notable for activity against:
  • Entamoeba histolytica,
  • Dientamoeba fragilis,
  • Diphyllobothrium latum,
  • Taenia saginata,
  • Cryptosporidium,
  • Giardia lamblia.

Pharmacokinetics

Absorption: Minimal to no systemic absorption.
Distribution: Unknown.
Metabolism and Excretion: 100% excreted in feces.
Half-life: Unknown.

Time/action profile

ROUTEONSETPEAKDURATION
POunknownunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to paromomycin or other aminoglycosides; Intestinal obstruction.
Use Cautiously in: Renal impairment; Ulcerative bowel lesions; Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Gastrointestinal

  • abdominal cramps
  • diarrhea
  • nausea
  • vomiting

Miscellaneous

  • hypersensitivity reactions

Interactions

Interactions are listed for systemically absorbed drug

Drug-Drug interaction

May enhance possible respiratory paralysis after inhalation anesthetics or neuromuscular blockers.↑ risk of ototoxicity with loop diuretics.May ↑ the anticoagulant effects of warfarin.May ↓ the absorption of digoxin and methotrexate.

Route/Dosage

Intestinal Amebiasis

Oral (Adults and Children) 8.33–11.67 mg/kg 3 times daily with meals for 5–10 days.

Hepatic Coma

Oral (Adults) 4 g/day in 2–4 divided doses for 5–6 days.

Availability (generic available)

Capsules: 250 mg

Nursing implications

Nursing assessment

  • Assess patient for infection (vital signs, stool) at beginning of and periodically throughout therapy.
  • Hepatic Coma: Monitor neurologic status. Prior to administering oral medication, assess patient's ability to swallow.

Potential Nursing Diagnoses

Risk for infection (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Keep patient well hydrated (1500–2000 mL/day) during therapy.
  • Oral: Administer with meals.

Patient/Family Teaching

  • Instruct patient to take as directed for full course of therapy. Missed doses should be taken as soon as possible if not almost time for next dose; do not double doses.
  • Advise patient of the importance of drinking plenty of liquids.
  • Caution patient that medication may cause nausea, vomiting, or diarrhea.
  • Advise patient to notify health care professional if ringing in the ears, hearing impairment, or dizziness occurs.

Evaluation/Desired Outcomes

  • Resolution of amebic infection.
  • Improved neurologic status in hepatic coma.
References in periodicals archive ?
The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials that have evaluated the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran.
The drug that is mostly used in topical treatments is paromomycin, while some other drugs such as imidazole and methylbenzethonium chloride [45-47].
Efficacy of albendazole and two different doses of paromomycin for treatment of naturally occurring giardia infection in lambs.
Most therapies for HE are directed at reducing nitrogenous load in the gut, an approach consistent with hypothesis that it results from systemic accumulation of gut-derived neurotoxins, especially ammonia, in patients with impaired liver function and porto-systemic shunting.8 Some oral antibiotics like neomycin, paromomycin, vancomycin, and metronidazole have been effectively used, with or without lactulose, to reduce the load of ammonia-producing enteric bacteria in patients with acute HE.9 Rifaximin is a minimally absorbed oral antimicrobial agent with broad-spectrum against enteric bacteria.
Verbrugghe et al., "Porcine intestinal epithelial barrier disruption by the Fusarium mycotoxins deoxynivalenol and T-2 toxin promotes transepithelial passage of doxycycline and paromomycin," BMC Veterinary Research, vol.
Treatment with a luminal agent such as paromomycin (25-30 mg/kg/day orally in three divided doses for seven days), diiodohydroxyquin (650 mg orally three times daily for 20 days), or diloxanide furoate (500 mg orally three times daily for 10 days) to eliminate intraluminal cysts is also warranted.
Other drugs like amphotericin B, ketoconazole, miltefosine, paromomycin, pentamidine etc may also be used for the treatment.
Since its inception in 2003, DNDi has delivered six treatments: two fixed-dose antimalarials (ASAQ and ASMQ), nifurtimox-eflornithine combination therapy (NECT) for late-stage sleeping sickness, sodium stibogluconate and paromomycin (SSG&PM) combination therapy for visceral leishmaniasis in Africa, a set of combination therapies for visceral leishmaniasis in Asia, and a paediatric dosage form of benznidazole for Chagas disease.
USA) with 1% sorbitol supplementation and Bifidobacterium lactis with MRS-NNLP agar (NNPL solution: Neomycin sulphate 100 mg, Paromomycin 200 g; Nalidixic acid 15 mg, LiCl 3 g per liter of media).
Besides oral and parenteral medications (pentavalent antimonials, liposomal amphotericin B, miltefosine, and some others), local cryotherapy, intralesional infiltration of sodium stibogluconate, local heat therapy, and various topical paromomycin preparations are in practice for many many years.
Shin et al., "Selection of nptll transgenic sweetpotato plants using G418 and paromomycin," Journal of Plant Biology, vol.