Prospective study of amikacin versus netilmicin in the treatment of severe infection in hospitalized patients.
OBJECTIVE
Four previous studies comparing netilmicin and amikacin have yielded inconclusive results concerning efficacy and rates of nephrotoxicity and ototoxicity. For this reason, we conducted a prospective, randomized, controlled trial of the two drugs in the treatment of hospitalized patients with severe infection.


METHODS
A total of 202 patients were enrolled in the study; 100 received netilmicin and 102 received amikacin. Concomitant antimicrobials were restricted to metronidazole and benzylpenicillin. Peak and trough aminoglycoside levels were assayed within the first 36 hours and at least every 72 hours thereafter. A full blood cell count, serum electrolytes, creatinine, bilirubin, and liver enzymes were measured before therapy, weekly thereafter, and within 48 hours after the discontinuation of therapy. Nephrotoxicity and ototoxicity were assessed in patients. A standard agar dilution procedure was used to determine minimal inhibitory concentrations.


RESULTS
No significant pretreatment differences were found between the two groups. Patients in the amikacin group responded significantly better to treatment than did patients in the netilmicin group (90% versus 79%; p less than 0.05). A notable finding was the markedly inferior response rate of Pseudomonas aeruginosa infections to netilmicin as compared with amikacin (13 of 24 with a favorable response compared with 25 of 26). No significant difference in ototoxicity was found, whereas nephrotoxicity appeared to be significantly less with amikacin (4% versus 12%, p less than 0.05). Although amikacin seemed less nephrotoxic than netilmicin, this may have been related to the significantly greater number of patients with initial renal dysfunction who received netilmicin.


CONCLUSIONS
Amikacin appears to be significantly more efficacious than netilmicin for the treatment of P. aeruginosa infections, especially those in non-urinary tract sites. There is no apparent difference between the two drugs in terms of ototoxicity.
Noone
M
M
Department of Microbiology, Royal Free Hospital, Hampstead, London, United Kingdom.
Pomeroy
L
L
Sage
R
R
Noone
P
P
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000009:adverse effects / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002986:Clinical Trials as Topic; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004423:Ear / Q000187:drug effects; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009428:Netilmicin / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011897:Random Allocation; D015163:Superinfection / Q000188:drug therapy / Q000382:microbiology
D009428:Netilmicin; D000583:Amikacin