Adult: 4-6 mg/kg daily as a single dose or in equally divided doses given 8 hourly or 12 hourly. For life-threatening infections: May give up to 7.5 mg/kg daily in divided doses 8 hourly. For UTI: 4 mg/kg daily or 150 mg 12 hourly. Doses are given via IM inj, slow IV inj over 3-5 minutes or IV infusion over 30 minutes to 2 hours. Dosage and treatment recommendations may vary among individual products or between countries (refer to detailed local or product guidelines). Child: Infants 7.5-9 mg/kg daily or 2.5-3 mg/kg 8 hourly; Children 6-7.5 mg/kg daily or 2-2.5 mg/kg 8 hourly. Doses are given via IM inj, slow IV inj over 3-5 minutes or IV infusion over 30 minutes to 2 hours. Dosage and treatment recommendations may vary among individual products or between countries (refer to detailed local or product guidelines).
Ophthalmic Ocular infections
Adult: For the treatment of external infections of the eye: Instil 1-2 drops into the affected eye(s) tid. Usual treatment duration: 5 days; longer treatment duration may be needed in refractory or complicated cases. Treatment recommendations may vary among individual products or between countries (refer to detailed local or product guidelines).
What are the brands available for Netilmicin in Thailand?
Netilmicin is an aminoglycoside antibiotic that inhibits bacterial protein synthesis by binding to the 16S ribosomal RNA (rRNA) subunit of the bacterial 30S ribosome, which is responsible for messenger RNA (mRNA) translation within the prokaryotic cell.
The MT-RNR1 gene encodes the human 12S rRNA subunit, the mitochondrial homologue of the prokaryotic 16S rRNA subunit. Certain MT-RNR1 gene variants may alter the human 12S rRNA subunit to resemble the bacterial 16S rRNA subunit more closely, thereby allowing the aminoglycosides to bind more readily. Patients who are carriers of MT-RNR1 gene variants may have an increased risk of aminoglycoside-induced ototoxicity (including potentially significant hearing loss) even when serum levels are within the normal range.
Although MT-RNR1 gene and uncertain risk variants are rare, genetic testing may be considered prior to treatment initiation but the testing should not delay the initiation of netilmicin therapy.
Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline as of May 2021:
Phenotype and Genotype
Implications
Recommendations
MT-RNR1 increased risk of aminoglycoside-induced hearing loss
Patients with MT-RNR1 variant associated with increased risk of aminoglycoside-induced hearing loss e.g. m.1095T>C, m.1494C>T, m.1555A>G
Very high risk of developing hearing loss if netilmicin is administered.
Avoid the use of netilmicin unless the increased risk of permanent hearing loss is outweighed by the severity of the infection and the lack of alternative therapies. If no effective alternative is available, frequently evaluate patients for hearing loss during treatment and ensure all appropriate precautions are utilised (e.g. lowest possible dose, shortest possible duration, renal function and therapeutic drug monitoring, hydration).
MT-RNR1 normal risk of aminoglycoside-induced hearing loss
Patients with no detectable MT-RNR1 increased risk variant or MT-RNR1 variant associated with normal risk of aminoglycoside-induced hearing loss e.g. m.827A>G
Normal risk of developing hearing loss if netilmicin is administered.
Use netilmicin at standard doses for the shortest possible course with therapeutic drug monitoring. Regularly evaluate for hearing loss in accordance with the local guidelines.
MT-RNR1 uncertain risk of aminoglycoside-induced hearing loss
Patients with MT-RNR1 variant associated with uncertain risk of aminoglycoside-induced hearing loss e.g. m.663A>G, m.669T>C, m.747A>G, m.786G>A, m.807A>G, m.807A>C, m.839A>G, m.896A>G, m.930A>G, m.951G>A, m.960C>del, m.961T>G, m.961T>del, m.961T>del+Cn, m.988G>A, m.1189T>C, m.1243T>C, m.1520T>C, m.1537C>T, m.1556C>T
Weak or no evidence of increased risk of MT-RNR1-associated hearing loss if netilmicin is administered.
Use netilmicin at standard doses for the shortest possible course with therapeutic drug monitoring. Regularly evaluate for hearing loss in accordance with the local guidelines.
Renal Impairment
Intravenous/Intramuscular:
Dose adjustment may be required.
Reconstitution
Solution for IV infusion: Adult: Dilute the appropriate dose in 50-200 mL NaCl 0.9% solution, dextrose 5% in water or other compatible diluents. Children: Dilute in appropriate volume of NaCl 0.9% solution, dextrose 5% in water or other compatible diluents depending on the patient's fluid requirements. Recommendations for dilution and concentration may vary among individual products and countries (refer to specific product or local guidelines).
Contraindications
Hypersensitivity to netilmicin or other aminoglycosides. Muscular disorders (e.g. myasthenia gravis).
Special Precautions
Patient with neuromuscular disorder (e.g. Parkinson's disease), known or family history of hearing impairment; dry eyes, conditions that may compromise the cornea (ophthalmic). Dehydrated patients. Patients with certain MT-RNR1 gene variants. Renal and hepatic impairment. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Nephrotoxicity; neuromuscular blockade, respiratory paralysis; neurotoxicity manifested as auditory and vestibular ototoxicity; fungal or bacterial superinfection (prolonged use), including Clostridioides difficile-associated diarrhoea and pseudomembranous colitis; vitamin K deficiency. Ophthalmic: Local sensitisation (e.g. redness, irritation). Blood and lymphatic system disorders: Eosinophilia, anaemia. Cardiac disorders: Palpitation, tachycardia. Ear and labyrinth disorders: Tinnitus, vertigo, hearing loss; ringing, buzzing or sense of pressure in the ears. Eye disorders: Eye pruritus, eye discomfort, eyelid rash, eyelid oedema, conjunctival hyperaemia (ophthalmic). Gastrointestinal disorders: Abdominal pain, diarrhoea, vomiting. General disorders and administration site conditions: Fever, inj site pain. Immune system disorders: Hypersensitivity reactions. Investigations: Increased AST, ALT, serum bilirubin, BUN, serum creatinine, alkaline phosphatase, prothrombin time or serum glucose; decreased platelet count or WBC. Nervous system disorders: Headache, dizziness. Psychiatric disorders: Disorientation. Skin and subcutaneous tissue disorders: Rash, urticaria.
Patient Counseling Information
Remove contact lenses before administration and reinsert after 15 minutes.
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor serum netilmicin concentrations; LFTs, renal function, urine output. Perform hearing tests (with prolonged use or high doses particularly in patients at risk for ototoxicity).
Overdosage
IV: Symptoms: Nephrotoxicity (e.g. increased BUN or serum creatinine, decreased CrCl), ototoxicity (e.g. tinnitus, dizziness, hearing loss), neurotoxicity (e.g. neuromuscular blockade with respiratory paralysis). Management: Perform haemodialysis to remove netilmicin from the blood.
Drug Interactions
Increased risk of ototoxicity with potent diuretics (e.g. etacrynic acid, furosemide). Enhanced neurotoxic and/or nephrotoxic effects with other aminoglycosides (e.g. amikacin, neomycin), vancomycin, viomycin, colistin, amphotericin B, polymyxin B, cisplatin and cephalosporins. Increased risk of prolonged neuromuscular blockade and respiratory arrest with neuromuscular blocking agents and anaesthetics.
Action
Description: Mechanism of Action: Netilmicin is a semisynthetic aminoglycoside with bactericidal action. It inhibits bacterial protein synthesis by binding to 30S ribosomal subunit, leading to a defective bacterial cell membrane. Pharmacokinetics: Absorption: Rapidly and completely absorbed (IM). Poorly absorbed after administration into the conjunctival sac. Time to peak plasma concentration: 0.5-1 hour (IM or IV). Distribution: Enters breast milk (small amounts). Volume of distribution: 0.15-0.3 L/kg. Excretion: Via urine (approx 80%). Elimination half-life: 2-2.5 hours.
Chemical Structure
Netilmicin Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 441306, Netilmicin. https://pubchem.ncbi.nlm.nih.gov/compound/Netilmicin. Accessed June 30, 2025.
Storage
Solution for inj: Store below 30°C. Do not freeze. Ophthalmic solution: Store below 25°C. Protect from light. Storage recommendations may vary among individual products or between countries (refer to detailed local or product guidelines).
J01GB07 - netilmicin ; Belongs to the class of other aminoglycosides. Used in the systemic treatment of infections. S01AA23 - netilmicin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
References
McDermott JH, Wolf J, Hoshitsuki K et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for the Use of Aminoglycosides Based on MT-RNR1 Genotype. Clinical Pharmacology & Therapeutics. 2022 Feb;111(2):366-372. doi: 10.1002/cpt.2309. Accessed 10/10/2024Annotation of CPIC Guideline for Amikacin, Dibekacin, Gentamicin, Kanamycin, Neomycin, Netilmicin, Paromomycin, Plazomicin, Ribostamycin, Streptomycin, Tobramycin and MT-RNR1. Pharmacogenomics Knowledgebase (PharmGKB). https://www.pharmgkb.org. Accessed 08/10/2024.Brayfield A, Cadart C (eds). Netilmicin Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/10/2024.Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for the Use of Aminoglycosides Based on MT-RNR1 Genotype. Clinical Pharmacogenetics Implementation Consortium (CPIC). https://cpicpgx.org. Accessed 10/10/2024.Joint Formulary Committee. Netilmicin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/10/2024.Lotifar 50 mg/mL Injection (Duopharma [M] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 08/10/2024.MT-RNR1 - Netilmicin. UpToDate Lexidrug, Pharmacogenomics Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 08/10/2024.Neminos (Sanbe Farma PT). MIMS Indonesia. http://www.mims.com/indonesia. Accessed 08/10/2024.Netilmicin (Ophthalmic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 08/10/2024.Netilmicin (Systemic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 08/10/2024.Nettacin 3 mg/mL Eye Drops, Solution (SIFI Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 08/10/2024.
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