II. Indications
- Complicated, drug-resistant Urinary Tract Infection (Enterobacteriaceae, ESBL, CRE)
III. Contraindications
- Pregnancy
- Not approved for use in children
IV. Mechanism
- See Aminoglycoside
- Bactericidal Aminoglycoside
V. Dosing
- Dosing Weight
- Based on Total Body Weight (TBW) and Ideal Body Weight (IBW)
- TBW< (IBW * 0.25)
- Use Total Body Weight for dosing
- TBW > (IBW * 0.25)
- Use Adjusted Body Weight = IBW + 0.4 * (TBW - IBW)
- Adults (eGFR >60 ml/min)
- Give 15 mg/kg IV infused over 30 minutes every 24 hours
- Plazomicin 500 mg vial (50 mg/ml) is diluted in NS or LR to total volume of 50 ml for infusion
- Diluted solution is stable at room Temperature for 24 hours after mixing
-
Renal Dosing in Adults (eGFR <60 ml/min)
- eGFR 30 to 60 ml/min: Give 10 mg/kg IV over 30 minutes every 24 hours
- eGFR 15 to 30 ml/min: Give 10 mg/kg IV over 30 minutes every 48 hours
- Avoid in eGFR <15 ml/min or Hemodialysis
VI. Pharmacokinetics
- Eliminated unchanged in urine (>97%)
- Half Life: 3 to 4 hours (when Renal Function is normal)
- Obtain baseline and daily Serum Creatinine and eGFR and follow levels (and Urine Output) carefully if eGFR <90 ml/min
- Target trough plasma levels (within 30 min of second dose): <3 mcg/ml
- If trough >3 mcg/ml, increase dosing interval by 1.5x (e.g. increase every 24 hour dosing to every 36 hours)
- At time of release, plasma levels were only available from Mayo Medical Labs
VII. Adverse Effects
- See Aminoglycoside
-
Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
- See Aminoglycoside for risk factors
IX. Resources
X. References
- (2018) Presc Lett, Resource #340921, New Drug: Zemdri (Plazomycin)
- (2018) Med Lett Drugs Ther 60(1559): 180-81