Kanamycin is an inhibitor of protein biosynthesisribosomeThe combination results in misreading of the mRNA code.If a bacterium produces an enzyme that destroys kanamycin, it can become a resistant strain.Kanamycin resistantplasmidIt is often used as a selective gene or marker gene in molecular cloning.
It can be used for oral and intravenous injection, and is effective against a variety of bacterial infections, from kanamycin streptomyces（Streptomyces kanamyceticus）Is separated from.
Compound kanamycin injection: each tube contains 360mg kanamycin sulfate andTrimethoprim18mg（2ml）。
Functional function
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Glomerular filtration metabolizes drugs
E. coliKlebsiella, Enterobacteriaceae, ProteusMycobacterium tuberculosisAnd some strains of Staphylococcus aureus are sensitive to this product.Pseudomonas aeruginosa,Gram positive bacteria(except Staphylococcus aureus), anaerobic bacteria, atypical branchesbacillusRickettsia, fungi and viruses are resistant to this product.Microbes have certain influence on the relationship between this product and other aminoglycosidesCross resistance。
After intramuscular injection of 0.5g, the blood drug concentration reached a peak in one hour, about 20 μ g/ml, and t1/2 was about 2.5 hours,Plasma protein binding rateVery low, the distribution volume (Vd) is 0.26 ± 0.05L/kg, after administration24 hours90% of the drugs are excreted in the original form from the urine.This product is easy to penetrate into pleural effusion and ascites.staycerebrospinal fluidMedium cannot reachEffective concentration。
Oral administration is used to treat intestinal infection caused by sensitive bacteria and to prepare for intestinal surgery, and has the effect of reducing ammonia production by intestinal bacteriacirrhosisLiver coma of patients with gastrointestinal bleeding can be prevented to some extent.
Intramuscular injection is used for systemic infection caused by sensitive bacteria, such as pneumonia, sepsisurinary tract infectionEtc.
Kanamycin diluted to a certain concentration is sprayed on cotton leaves, which can be used to identify whether it is Bt transgenic insect resistant cotton. Yellowing leaves are not resistant to cotton bollworm, and non discoloring leaves are insect resistant cotton[2]
Usage and dosage
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1. Adult intramuscular injection orvein0.5g (calculated by kanamycin, the same below) once, and 1-1.2g a day.Or according to the weight of 5mg/kg,
Creatinine clearance
Once every 8 hours;Or once every 12 hours according to the weight of 7.5mg/kg.The daily dosage for adults shall not exceed 1.5g, and the course of treatment shall be 7-10 days.2. The commonly used dosage for children is 15~25mg/kg per day, divided into two times.
3. Other usages 0.25% solution of this product can be used for rinsingthe focusThe injection can be used for aerosol inhalation.
Creatinine clearance
(1) Blood drug concentration should be monitored, especially for newborns, the elderly andrenal functionFor incomplete patients, the effective therapeutic concentration of kanamycin ranges from 15 to 30 μ g/ml.It should be avoided that the peak blood concentration is more than 30-35 μ g/ml and the valley concentration is more than 5 μ g/ml.
(2) If the blood concentration cannot be measuredcreatinineThe clearance rate adjusts the dose.
(3) After the first saturated dose (5-7.5mg/kg), the maintenance dose used in patients with renal insufficiency, vestibular function or hearing loss should be reduced, that is, the dose should remain unchanged, and the administration interval should be prolonged;Or the administration interval remains unchanged, and the dosage is reduced or kanamycin is stopped each time.Its maintenance amount can be calculated as follows:
① Extend the administration interval (hours), with the dosage unchanged each time (7.5mg/kg), and the administration interval=the patient's blood creatinine value (mg/100ml) × 9
② Reduce the dosage of each dose, once every 12 hours: dosage per dose=patientBlood creatinineClearance rate (mg/min) × 7.5 (mg/kg)/creatinine clearance rate of normal people (mg/min).Because kanamycin is not metabolized in the body and is mainly excreted through urine, patients with renal dysfunction may cause drug accumulation to toxic concentration.
(4) Patients should be given enough water to reduceRenal tubuleDamage.
(6) Preparation of kanamycin sulfate intravenous drip solution: undilutedKanamycin sulfateInjections cannot be directly injectedintravenous injection。Take kanamycin sulfate injection and use sodium chloride injection or 5%Glucose InjectionDilution;Or add kanamycin sulfate for injection firstSterilized water for injectionAfter dissolution, add 200-400ml of sodium chloride injection or 5% glucose injection or other appropriate sterile diluents to every 1g of kanamycin: the solution should be dropped within 30-60 minutes after preparation, and children should reduce the amount of diluents accordingly.This product can only be used for intramuscular injection andIntravenous drip, static pushing is not allowed.
matters needing attention
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(1) Use with caution in patients with renal insufficiency.
(2) AminoglycosidetoxicityIt is closely related to its blood concentration.In order to prevent the blood concentration from suddenly rising, this product can only be used for intramuscular injection and intravenous drip. It has respiratory inhibition effect and can not be used for intravenous injection to prevent accidents.
dynamics
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The product is rapidly absorbed after intramuscular injection, and a certain amount of drug can be absorbed from the body surface after local washing or local application.Mainly distributed in extracellular fluid, normalbabyThe concentration in cerebrospinal fluid can reach 10-20% of the blood concentration at the same time, whenMeningesWhen there is inflammation, it can reach 50% of the blood concentration in the same period.5~15% of the drug amount is redistributed to various tissues, which can be accumulated in renal cortical cells and cross the placenta.Synovial fluidMore than 50% of the blood concentration, bronchial secretionsbileandAqueous humorMedium low concentration.The drug accumulation in pleural effusion is slow, but it can gradually reach the same concentration as that in blood.The distribution volume is 0.26L/kg.After intramuscular injection, the blood concentration reached the peak value 1-2 hours, and the bile concentration reached the peak value about 6 hours after intramuscular injection.
Average blood drug after one administration of 7.5mg/kgPeak concentration22 μ g/ml, the concentration may be low in patients with fever or severe burns.The concentration in urine is 10-20 times of that in blood.T1/2 adults: 2-4 hours,renal function27~80 hours for the injured;premature infant18 hours, and 6-8.6 hours for full-term newborns (inversely proportional to birth weight and age).This product is not metabolized in the body, mainly throughglomerulusFiltration, about 50% will be discharged within 4 hours after administration, the concentration in urine can be as high as 800 μ g/ml, and about 80-90% will be discharged within 24 hours;The output in bile is about 1%;A small amount can also be discharged from the milk. Blood and peritoneal dialysis can remove a considerable amount of medicine from the blood, so thatHalf life of drugGreatly shortened.
Adverse reactions
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Those with high incidence rate have hearing loss, tinnitus or ear fullness (ototoxicity),hematuria, decreased urination frequency or urine output, anorexia
Adverse reaction - erythema rash
Thirst (nephrotoxicity), gait instability, dizziness (ototoxicity, vestibular impact), nausea or vomiting (ototoxicity, vestibular impact, nephrotoxicity).The patients with less incidence have dyspnea, lethargy or weakness (neuromuscular block, nephrotoxicity).Hearing loss, tinnitus or ear fullness after drug withdrawal indicate possible ototoxicity and need attention.May have hearing and kidney damage. May causeGastrointestinal reactions: nausea, vomiting, loss of appetite, abdominal distention, diarrhea, occasional allergic reaction,rash, drug fever, etcshockDeath. There may also be nervous system symptoms, myocardial depression,respiratory failureEtc.
Anaphylactic reaction
Drug fever and rash are not common, and their incidence is between 1% and 3%;butEosinophiliaIt is quite common, up to 10%, especially when the course of treatment exceeds one week.AnaphylaxisshockOccasionally, there was a case reported in China due toperforated peptic ulcer Anaphylactic shock caused by kanamycin injection was recovered after rescue and gentamicin was used insteadAdverse reactions。
nervous system
Cochlear nerve
The most important adverse reaction in the application of this product is influenceCochlear nerveThe patient's high-frequency hearing was damaged first, and then hearing loss gradually developed to deafness.Tinnitus and ear saturation are early and important8th cranial nervePrecursors of damage.Hearing loss mostly occurs and continues to progress in the course of treatment, but it may still occur after drug withdrawal, especially in patients with original renal function decline.The hearing loss caused by kanamycin is mostly bilateral, and the symptoms of some patients may gradually alleviate after drug withdrawal.Easily inducedOtotoxicityThe related factors are: ① those with decreased original renal function; ②The blood drug concentration lasts above 30 μ g/ml for a long time; ③The course of treatment is long.When the total amount does not exceed 15g, ototoxicity symptoms will not occur generally. 1g intramuscular injection is given every day for 30~150 consecutive days, and hearing damage can be up to 40%; ④Older patients; ⑤Have suffered in the pasttympanitisOr original hearing loss; ⑥Used in the pastAminoglycosidesOther ototoxic drugs or strong diuretics and other ototoxic drugs used together.
According to statistics, the incidence of clinical ototoxicity in kanamycin treatment is about 5%.The ototoxicity of kanamycin in neonates and preterm infants is rare. It is reported that the commonly used dose of kanamycin in adults (15mg/kg/day) often cannot reach the effective blood concentration in children. Therefore, it is suggested that the dose of kanamycin in children should be increased to 10mg/kg per time and intramuscular injection every 8 hours.Nevertheless, kanamycin should be used with caution in children.The cochlear nerve damage caused by this product can continue to develop after drug withdrawal. The ototoxicity of kanamycin is more severe than that of streptomycingentamicinEqual is greater, but lower thanneomycin。
Calcium gluconate can relieve respiratory depression
It is rare for this product to cause vestibular damage in the course of treatment.This product andstreptomycinThe same as neomycin, it can also blockNeuromuscular junctionCaused byRespiratory depression, onEtherIntraperitoneal administration under anesthesia is more likely to occur, and it also occurs after intramuscular or intravenous injection.Blockage of neuromuscular junction can also cause myocardial inhibition and blood pressure decrease.Intravenous injection of calcium gluconate can restore some cases.In addition, this product can also cause temporary damage to the ninth brain nerve function (manifested as loss of taste in the second third), sensory abnormalities around the mouth and other parts, headache, restlessnessTachycardia、Acute brain syndrome with hysteriaAnd visual abnormalities.
urinary system
This product can also cause kidney damage, and its toxicity to the kidney is lower than neomycin but greater than streptomycin.Transparent tube type and granular tube type can appear in urine, sometimes with a small amount of redwhite blood cellProteinuria is occasionally seen, mostly transient, and a few patients, especially the elderly, may have renal dysfunction;There are also individual reports of oliguria and acute renal necrosis.Renal lesions caused by kanamycin are reversible and can be recovered quickly after drug withdrawal. Those with severe lesions recover slowly or partially.
digestive system
Oral administration may cause nausea, vomiting, diarrhea, and even malabsorption after long-term useFatty diarrheaEtc.[Others] The incidence of local pain caused by intramuscular injection of this product is high, and it is generally tolerated.It can occasionally cause leukopenia,thrombinExtension of original timeFibrinogenDecrease and hypertension, etc.Double infection(byPseudomonas aeruginosaOr other gram-negative bacteriaDrug resistanceStaphylococcus aureusBacteroides(caused by genus, etc.).
taboo
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Use with caution in patients with renal insufficiency.
(1) And strongDiuretic(such as furosemideEtaniac acidCombined use can enhance ototoxicity.(2) With othersOtotoxicityDrugs (e.gerythromycinThe possibility of ototoxicity may be strengthened by combined application.
(3) AndCephalosporinsCombined application can increase nephrotoxicity.dextranIt can enhance the nephrotoxicity of this kind of drugs.
(4) AndMuscle relaxationDrugs or drugs with this effect (such asdiazepam Combined application may cause nerve -Muscle blockStrengthened role.Neostigmine
Dextran can increase or decrease the nephrotoxicity of this product
Or other anticholinesterase drugs can antagonize neuromuscular block.(5) This kind of drugs and alkaline drugs (such assodium bicarbonate, aminophylline, etc.), the antibacterial effect can be enhanced, but at the same time, the toxicity also increases accordingly, so we must be cautious.
(6) PenicillinsstreptococcusIts antibacterial effect can be enhanced by the combination of aminoglycosides, such as grass green streptococcal endocarditis andenterococcusInfection in applicationpenicillinAt the same time, streptomycin (or other aminoglycosides) can be added.However, it is not certain whether other bacteria have synergistic effects, and there are even reports of treatment failure caused by the combination of two drugs. Therefore, the combination of these two drugs must follow their indications and not be used randomly.
medicament
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Eye drops preparation
pharmacological action
Drugs enter the fetal circulation through the placenta
Kanamycin is an aminoglycoside antibiotic.For most Enterobacteriaceae bacteria, such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Shigella, Salmonella, Citrobacter, ProfeddenYersiniaAll have good effects;Influenza bacillus, Brucella, MeningococciGonococcusMost of them are also sensitive to this product, and have no effect on Pseudomonas aeruginosa.It also has certain effect on methicillin sensitive strains and Mycobacterium tuberculosis in Staphylococcus, and other gram-positive bacteria such asStreptococcus hemolyticusStreptococcus pneumoniae, enterococci and anaerobes are mostly resistant to this product.Kanamycin mainly binds to bacterial ribosome 30S subunit to inhibit bacterial protein synthesis.Kanamycin is completely cross resistant to streptomycin and neomycin, and may be partially resistant to other aminoglycosidesCross resistance。This product is colorless or yellowish clear liquid.
dynamics
After eye drops, this product is rarely absorbed into eye tissues or into the whole blood circulation.
indication
Eye drops for meiboadenitis
It is suitable for the treatment of conjunctivitis caused by sensitive Escherichia coli, Klebsiella, Proteus, Neisseria gonorrhoeae, Staphylococcus and other bacteriakeratitis, dacryocystitisBlepharitis、Tarsal adenitisAnd so on.
Usage and dosage
Drop into the eyeconjunctivaIn the capsule, 1-2 drops at a time, 3-5 times a day.
Adverse reactions
Occasionally, there is slight irritation and discomfort to the eyes, and there is no systemic adverse reaction.
taboo
It is forbidden for those allergic to this product or other aminoglycosides.
matters needing attention
1. This product shall not be injected directlyBulbar conjunctivaDown orIn anterior chamber。 2. Infection of lacrimal sac（Dacryocystitis）Often occurs inLacrimal sac duct occlusionIn addition to eyedrops of this product, local hot compress can also be used for children of.
3. The mouth of the bottle should not touch the eyes when dropping eyes. After use, the bottle cap should be tightened to avoid polluting the liquid medicine.Although this product is rarely absorbed into the whole blood circulation after eye drops, pregnant women and lactating women should still pay attention not to overuse it to avoid affecting the growth and development of the fetus and baby.
Interaction
This product is not suitable for use with capreomycin
1. It can increase ototoxicity, nephrotoxicity and neuromuscular blocking effect when used in combination with other aminoglycosides or locally.2. andCapreomycin, cisplatin, etaniac acid, furosemide or vancomycin (orNorvancomycin）Ototoxicity and nephrotoxicity may be increased if it is used in combination with or successively applied locally.
3. Local combination with cephalothiophene or cefazolin may increase nephrotoxicity.
4. Other nephrotoxic drugs and ototoxic drugs should be carefully used together or successively with this product to avoid aggravating nephrotoxicity or ototoxicity.
preparation
1、8ml:40mg
Direction of veterinary medicine treatment
pigasthmaThe disease is also called pig endemic epidemicpneumoniaIt is a chronic lung disease of pigs. The main symptoms are cough and asthma.
Combination with cefazolin sodium will increase nephrotoxicity
1. Fashion characteristics.The disease can be infected regardless of individual, age and breed. Lactating piglets and piglets are most susceptible to the diseaseLactating sowSecond, finishing pigs are generally chronically infected.The main route of infection is through the respiratory tract of pigs.There is no obvious seasonal feature of the disease, but it often occurs in winter, spring and the changing seasons. In addition, humidity, high density, poor ventilation and other factors are also easily induced.At present, the incidence of the disease is high, the symptoms are not obvious, and the mortality is low.In actual production, most of them died from secondary infection with other respiratory diseases.
2. Symptoms.The main symptoms were cough and asthma, while the body temperature and appetite were generally normal;The patients with long course of disease showed low spirit, thin body, coarse hair, slow growth, and increased feed to meat ratio.
3. Sectional inspection.The lesion is confined to the lung and abdominal cavitylymph glandLocation, in which bilateral lung lobes are symmetrical“Pancreatoid transformation”。
Kanamycin eye drops products
4. Differential diagnosis.It is mainly different from swine influenzaPig pulmonary diseaseInfectious pleurisy.Influenza: Sudden outbreak, rapid transmission, elevated pig temperature, short course of disease (about 1 week), short epidemic period.Swine asthma: the temperature of pigs is not high, the course of disease is long, the transmission is slow, and the epidemic period is short.Pneumopneumonic disease of pigs: most acute cases are septicemia andFibrinous pleuropneumoniaSymptoms: serious systemic symptoms, short course of disease, septicemia and fibrinous pleuropneumonia on autopsy;In chronic cases, the body temperature is uncertain, the cough is heavy, the asthma is light, and the body is severely emaciated. At the time of autopsy, suppurative or necrotic foci of different sizes of the liver can be seen.Swine asthma: the temperature and appetite of pigs have no significant changes, the lungs have pancreatic lesions, and there are no changes in sepsis and pleurisy.porcine contagious pleuropneumonia : The pig's body temperature rises, the systemic symptoms are serious, and there are pleurisy symptoms at autopsy;Swine asthma: the temperature of pigs is not high, the systemic symptoms are mild or asymptomatic, and the lungs have pancreatic lesions without pleurisy.
5. Prevention measures. ⑴At the same time of strengthening daily management, the epidemic area (field) shall be inoculated with attenuated vaccine of pig asthma disease. The breeding male and female pigs shall be vaccinated twice a year, and the piglets shall be immunized once at the age of 15-18 days. ⑵Kanamycin sulfate was injected intramuscularly, 30000 to 50000 units/kg body weight, twice a day.
Injectable preparation
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pharmacological action
Kanamycin injection
Kanamycin sulfate is a kind ofAminoglycoside antibiotics。This product is suitable for mostEnterobacteriaceaeBacteria such as Escherichia coli, Klebsiella, Enterobacter, ProteusShigella, SalmonellaCitrobacterGenusProfedenellaGenusYersiniaGenus has good antibacterial effect;Haemophilus influenzaeBrucella, Neisseria meningitidisNeisseria gonorrhoeaeMost of them are also sensitive to this product.Kanamycin against Staphylococcus（MethicillinSensitive strains) andMycobacterium tuberculosisIt also has a certain effect onPseudomonas aeruginosaInvalid.Other gram-positive bacteria such as hemolytic streptococcusStreptococcus pneumoniae , Enterococcus andAnaerobic bacteriaMost of them are resistant to this product.In recent years, the number of drug-resistant strains has increased significantly, because some bacteria produce aminoglycosidesInactivating enzyme, make it loseantibacterial activity。Kanamycin is completely cross resistant to streptomycin and neomycinAminoglycosideClass A may have partial cross resistance.This product is mainly related to bacteriaribosome30S subunit binding, inhibiting bacterial protein synthesis.This product is white or almost white powder.
dynamics
After intramuscular injection, the product is rapidly absorbed and reaches blood within 1~2 hoursDrug peak concentration。After 0.5g intramuscular injection, the average peak blood concentration (Cmax) was 20mg/L.bloodElimination half-life(T1/2a) is 2-4 hours,serum albuminLow binding rate.T1/2a was significantly prolonged in patients with renal dysfunction.Kanamycin can be distributed to various tissues in the body, accumulated in renal cortical cells, and has a high concentration in pleural fluid and ascites, which can pass through the placenta into the fetus.The concentration in bile and feces is low.This product rarely enters cerebrospinal fluid.This product is not metabolized in the body, mainly throughglomerulusIt is discharged from urine after filtration, and 80%~90% of it is discharged from urine within 24 hours after administration.Hemodialysis and peritoneal dialysis can remove a considerable amount of drugs.
indication
This product is suitable for sensitive enterobacteriaceae bacteria such as Escherichia coli, KlebsiellaProteusSevere infection caused by Enterobacter aerogenes, Shigella, etc., such as pneumoniasepticemia, abdominal infection, etc., often with otherAntibacterialsJoint application.
Usage and dosage
1. The commonly used dose for adults is intramuscular injection or intravenous drip, 0.5g once, once every 12 hours;Or according to the weight of 7.5mg/kg, once every 12 hours, the daily dosage of adults should not exceed 1.5g, and the course of treatment should not exceed 14 days.The dose of patients over 50 years old should be appropriately reduced.2. Children were given intramuscular injection or intravenous drip of the usual amount, according to the weight of 15-25 mg/kg per day, twice.
3. The 0.25% solution of kanamycin sulfate can be used as washing solution.0.1% solution can also be used for aerosol inhalation.2.5% of the injection can be used for intraperitoneal administration.
4. Dosage for renal dysfunction:creatinineThe clearance rate is 50~90mg/min, 60%~90% of the normal dose is used, once every 12 hours (the normal dose is 7.5mg/kg, once every 12 hours);Creatinine clearance rate: 10~50ml/min, 30%~70% of the normal dose, once every 12~18h;When creatinine clearance rate is less than 10mg/min, use 20%~30% of normal dose, once every 24~48 hours.
Adverse reactions
1. In the course of treatment, hearing loss, tinnitus or ear fullness may occur, which is caused by affecting the cochlear nerve.A small number of patients, especially those with original renal dysfunction, can occur after drug withdrawal, which should be noted.Vertigo and gait instability may occur when vestibular nerve function is affected, but they are rare.2. Renal toxic reactions such as hematuria, decreased urination frequency or urine volume, anorexia, nausea, vomiting, extreme thirst may occur.
2. Pay attention to the following examinations during drug use: (1) Routine urine examination and renal function test to prevent seriousNephrotoxicityReaction.(2) Audiometry or audiogram, especially high frequencyAudiometry, which is more important for the elderly.3. When conditions permit, the blood concentration should be monitored, especially for newborns, the elderly and patients with impaired renal function.When the drug is administered once every 12 hours, the peak blood concentration should be kept at 15~30mg/ml, and the valley concentration should be 5~10mg/ml;When the drug is administered once every 24 hours, the peak blood concentration should be kept at 56 ～ 64mg/ml, and the valley concentration should be<1mg/ml.
4. The product should be used with caution in the following cases: (1) Water loss can increase the blood concentrationToxic reactionThe possibility of.(2) The 8th is brain nerve damage, because this product can cause auditory nerve and vestibular function damage.(3)myasthenia gravisOr Parkinson's disease, because this product can cause neuromuscular block, resulting in skeletal muscle weakness.(4) If the renal function is damaged, this product may cause nephrotoxicity.
5. Interference to diagnosis: can make alanine aminotransferase (ALT)Aspartate aminotransferase(AST), serum bilirubin concentration and serum lactate dehydrogenase concentration increased;blood calciumThe measured values of magnesium, potassium and sodium concentrations may decrease.
6．AminoglycosideClass A and β - lactam (cephalosporins and penicillins) can cause mutual inactivation when mixed.When kanamycin is used in combination with the above antibiotics, it must be dripped in separate bottles.Kanamycin should not be dropped in the same bottle with other drugs.
Drugs enter the fetal circulation through the placenta
Routine urine examination is required during medication
7. This product may cause ototoxicity and nephrotoxicity, so it is not suitable for long-term treatment (such as mycobacterial disease), and the course of treatment usually does not exceed 14 days.This product belongs to aminoglycosides, which should be used with caution in pediatrics, especially in premature infants and newborns. Because its kidney tissue is not fully developed, this kind of drughalf lifeProlonged, the drug may accumulate in the body and produce toxic reactions.This product belongs to Class D when used by pregnant women, that is, it is harmful to human beings, but the advantages may outweigh the disadvantages after use.This product can pass through the placenta and enter the fetal tissue, which may cause hearing damage to the fetus.Pregnant women must fully weigh the advantages and disadvantages before using this product.The secretion of this product in milk is very low, but it is usually advisable to stop breastfeeding during the medication period.The application of this product in elderly patients is liable to cause various toxic reactions, so the blood drug concentration should be monitored in the course of treatment when conditions permit. In addition, the renal function of elderly patients has a certain degree of physiological decline, and even if the measured value of their renal function is within the normal range, a small amount of treatment should be used.
Overtreatment
If kanamycin is excessive or causes toxic reaction due to lack of specific antagonist, symptomatic therapy andSupportive therapyAnd replenish a lot of water at the same time.Hemodialysisorperitoneal dialysisHelps to remove kanamycin from the blood.
Interaction
1. It can increase ototoxicity, nephrotoxicity and neuromuscular blocking effect when used in combination with other aminoglycosides or applied locally or systematically.2. Combined with neuromuscular blockers, it can aggravate neuromuscular blocking effect, resulting in muscle weaknessRespiratory depressionEtc.
3. With capreomycinCisplatin, etaniac acid, furosemide orvancomycin(or norvancomycin), or successively applied locally or systemically, may increase ototoxicity and nephrotoxicity.
Combination with cefazolin sodium will increase nephrotoxicity
4. With Cefothiophene orCefazolinLocal or systemic use may increaseNephrotoxicity。 5.&PolymyxinCombined use of Class A injection, or continuous local or systemic application, can increase nephrotoxicity and neuromuscular blocking effect.
6. Other nephrotoxic drugs and ototoxic drugs should not be used together or successively with this product to avoid aggravating nephrotoxicity or ototoxicity.
