Paromomycin

INTRODUCTION

Indications

Treatment of acute and chronic intestinal amebiasis. Management of hepatic coma as adjunctive therapy (i.e., used to control intestinal bacteria that can produce ammonia and worsen encephalopathy related to liver failure).

Action

Inhibits protein synthesis in bacteria at level of 30S ribosome. Therapeutic Effects: Resolution of amebic infections. Spectrum: Notable for activity against Entamoeba histolytica, Dientamoeba fragilis, Diphyllobothrium latum, Taenia saginata, Cryptosporidium, Giardia lamblia.

Adverse Reactions/Side Effects

GI: abdominal cramps, diarrhea, nausea, vomiting. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

Interventions

• Make sure patient remains adequately hydrated to offset fluid loss from diarrhea.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report severe or prolonged GI problems including diarrhea, nausea, vomiting, and abdominal cramps.

Pharmacokinetics

Absorption: Minimal to no systemic absorption.

Distribution: Unknown.

Metabolism and Excretion: 100% excreted in feces.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to paromomycin or other aminoglycosides; Intestinal obstruction.

Use Cautiously in: Renal impairment; Ulcerative bowel lesions; Pregnancy, lactation, infants, and neonates (safety not established).

Interactions

Interactions are listed for systemically absorbed drug

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

Route/Dosage

Intestinal Amebiasis

PO (Adults and Children): 8.33–11.67 mg/kg tid with meals for 5–10 days.

Hepatic Coma

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

Availability

Capsules: 250 mg.