Spectinomycin is an aminocyclitol antibiotic that is structurally related to aminoglycosides. It lacks amino sugars and glycosidic bonds.
Spectinomycin is active in vitro against many Gram-positive and Gram-negative organisms, but it is used almost solely as an alternative treatment for drug-resistant gonorrhea or gonorrhea in penicillin-allergic patients. The majority of gonococcal isolates are inhibited by 6 mcg/mL of spectinomycin. Strains of gonococci may be resistant to spectinomycin, but there is no cross-resistance with other drugs used in gonorrhea. Notably, it is not recommended for treatment of pharyngeal gonococcal infec-children).There is pain at the injection site and, occasionally, fever tions due to high failure rates regardless of in vitro susceptibility. and nausea. Nephrotoxicity and anemia have been observed rarely. Spectinomycin is rapidly absorbed after intramuscular injection. Spectinomycin is no longer available for use in the USA but is still The standard regimen is a single dose of 2–4 g/d (40 mg/kg in recommended elsewhere.
• Gentamicin Prevents bacterial protein synthesis by binding to the 30S ribosomal subunit Bactericidal activity against effects against Gram-positive bacteria when combined with β-lactams or endocarditis caused by streptococci, staphylococci, and enterococci
IV • renal clearance (half-life 2.5 h) • conventional dosing 1.3–1.7 mg/kg q8h with goal peak levels 5–8 mcg/mL • trough levels <2 mcg/mL • once-daily dosing at 5–7 mg/kg as effective and • Toxicity: Nephrotoxicity (reversible), ototoxicity (irreversible), neuromuscular blockade
Tobramycin: Intravenous; more active than gentamicin versus Pseudomonas; may also have less nephrotoxicity
Amikacin: Intravenous; resistant to many enzymes that inactivate gentamicin and tobramycin; higher doses and target peaks and troughs than gentamicin and tobramycin
Streptomycin: Intramuscular, widespread resistance limits use to specific indications such as tuberculosis and enterococcal endocarditis
Neomycin: Oral or topical, poor bioavailability; used before bowel surgery to decrease aerobic flora
Spectinomycin: Intramuscular; sole use is for treatment of antibiotic-resistant gonococcal infections or gonococcal infections in penicillin-allergic patients; not available in the USA
Amikacin Generic, Amikin
Kanamycin Generic, Kantrex
Neomycin Generic, Mycifradin
Paromomycin Generic, Humatin
Tobramycin Generic, Nebcin
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