Capreomycin

Tuberculosis

Parenteral Tuberculosis Indicated in pulmonary infections caused by capreomycin-susceptible strains of M. tuberculosis (TB) when primary agents (isoniazid, rifampin, ethambutol, aminosalicylic acid, and streptomycin) have been ineffective or cannot be used because of toxicity or presence of resistant tubercle bacilli Adult: 1 g daily, by deep IM inj or IV infusion, for 2-4 months, then 2-3 times weekly for the remainder of the therapy. Max: 20 mg/kg/day.

RENAL IMPAIRMENT Nephrotoxic; ototoxic. Dose adjustments: Reduce dose.

IV Preparation Dissolve 1 g powder with 2, 2.15, 2.63, 3.3, or 4.3 mL of NS or SWI Allow 2-3 min to dissolve IV/IM Administration IM: deep IM into large muscle mass IV: dilute with 100 mL NS & infuse over 1 hr

Hypersensitivity to capreomycin and other aminoglycosides.

Use of capreomycin have been associated with worse clinical outcomes (ie, decreased effectiveness, increased mortality) compared to other parenteral therapy for pulmonary multidrug-resistant tuberculosis (MDR-TB) Reserve capreomycin for patients with MDR-TB resistant to IV aminoglycosides and have limited treatment options Caution in patients with renal or preexisting auditory impairment; weigh risk of additional impairment of cranial nerve VIII and/or kidneys against benefits from therapy Concomitant use of capreomycin and other IV antituberculosis agents (streptomycin, viomycin) are not recommended Use extreme caution if administered with other ototoxic or nephrotoxic drugs (polymyxin A sulfate, colistin sulfate, amikacin, gentamicin, tobramycin, vancomycin, kanamycin, and neomycin) Caution in renal impairment and history of allergic reactions Risk of hypokalemia Risk of rare but potentially fatal toxic nephritis May be associated with worse clinical outcomes, ie, decreased effectiveness and increased mortality, compared with other parenteral therapy for pulmonary MDR-TB Audiometric measurements and assessment of vestibular function should be performed prior to initiation of therapy and at regular intervals during treatment Peripheral neuromuscular blocking action attributed to other polypeptide antibiotics (colistin sulfate, polymyxin A sulfate, paromomycin, and viomycin) and to aminoglycoside antibiotics (streptomycin, dihydrostreptomycin, neomycin, and kanamycin) studied; a partial neuromuscular blockade was demonstrated after large intravenous doses of this drug; action was enhanced by ether anesthesia (as has been reported for neomycin) and antagonized by neostigmine Renal injury Renal injury, with tubular necrosis, elevation of blood urea nitrogen (BUN) or serum creatinine, and abnormal urinary sediment, noted; slight elevation of BUN and serum creatinine observed in a significant number of patients receiving prolonged therapy The appearance of ca

Not Classi Pregnancy Safety in pregnancy not determined; there are no adequate and well-controlled studies in pregnant women; therapy has been shown to be teratogenic in rats when given in doses 3 1/2 times human dose;. This drug should be used during pregnancy only if potential benefit justifies potential risk to fetus Lactation Not known whether this drug is excreted in human milk; because many drugs are excreted in human milk, caution should be exercised when this drug is administered to a nursing woman

Additive and sometimes irreversible toxic effects w/ other parenteral anti-TB agents (e.g. streptomycin, viomycin). Increased risk of nephrotoxicity and ototoxicity w/ other non-antituberculosis drugs (e.g. polymyxin A sulfate, amikacin, gentamicin, tobramycin, vancomycin, kanamycin, neomycin). Contraindicated (0) Serious (10) amphotericin B deoxycholate atracurium cidofovir cisatracurium neomycin PO pancuronium rapacuronium rocuronium succinylcholine vecuronium

>10% Nephrotoxicity, incr BUN (36%) Hearing loss (11% subclinical; 3% clinical) 1-10% Eosinophilia (dose related, >5%) <1% Incr LFTs Inj site pain/induration Leukopenia Maculopapular rash Urticaria

Capreomycin is a cyclic polypeptide antimicrobial. It is bacteriostatic against various Mycobacteria, particularly those that have become resistant to primary anti-TB drugs.