paromomycin

[par´ah-mo-mi″sin] a broad-spectrum antibiotic derived from Streptomyces rimosus var. paromomycinus; the sulfate salt is used as an antiamebic.

paromomycin

(par-oh-moemye-sin) paromomycin

Classification

Therapeutic: amebicide
Pregnancy Category: C

Indications

Treatment of acute and chronic intestinal amebiasis.Management of hepatic coma as adjunctive therapy.

Action

Inhibits protein synthesis in bacteria at level of 30S ribosome.

Therapeutic effects

Resolution of amebic infections.Notable for activity against:

Entamoeba histolytica,

Dientamoeba fragilis,

Diphyllobothrium latum,

Taenia saginata,

Cryptosporidium,

Giardia lamblia.

Pharmacokinetics

Absorption: Minimal to no systemic absorption.Distribution: Unknown.Metabolism and Excretion: 100% excreted in feces.Half-life: Unknown.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to paromomycin or other aminoglycosides; Intestinal obstruction.Use Cautiously in: Renal impairment; Ulcerative bowel lesions; Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Gastrointestinal

abdominal cramps
diarrhea
nausea
vomiting

Miscellaneous

hypersensitivity reactions

Interactions

Interactions are listed for systemically absorbed drug

Drug-Drug interaction

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

Route/Dosage

Intestinal Amebiasis

Oral (Adults and Children) 8.33–11.67 mg/kg 3 times daily with meals for 5–10 days.

Hepatic Coma

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

Availability (generic available)

Capsules: 250 mg

Nursing implications

Nursing assessment

Assess patient for infection (vital signs, stool) at beginning of and periodically throughout therapy.
Hepatic Coma: Monitor neurologic status. Prior to administering oral medication, assess patient's ability to swallow.

Potential Nursing Diagnoses

Risk for infection (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

Keep patient well hydrated (1500–2000 mL/day) during therapy.
Oral: Administer with meals.

Patient/Family Teaching

Instruct patient to take as directed for full course of therapy. Missed doses should be taken as soon as possible if not almost time for next dose; do not double doses.
Advise patient of the importance of drinking plenty of liquids.
Caution patient that medication may cause nausea, vomiting, or diarrhea.
Advise patient to notify health care professional if ringing in the ears, hearing impairment, or dizziness occurs.

Evaluation/Desired Outcomes

Resolution of amebic infection.
Improved neurologic status in hepatic coma.