AHFS/Drugs.com Monograph CAS ID 1263-89-4 | MedlinePlus a601098 Molar mass 615.629 g/mol | |
 | ||
Trade names Catenulin, Aminosidine, others Pregnancy
category US: N (Not classified yet)
C Routes of
administration By mouth, intramuscular, topical ATC code A07AA06 (WHO)
QJ01GB92 (WHO) | ||
Paromomycin is an antibiotic used to treat a number of infections including amebiasis, giardiasis, leishmaniasis, and tapeworm infection. It is a first line treatment for amebiasis or giardiasis during pregnancy. Otherwise it is generally a second line treatment option. It is used by mouth, applied to the skin, or by injection into a muscle.
Contents
- Medical uses
- Pregnancy and breastfeeding
- HIVAIDS
- Adverse effects
- Interactions
- Mechanism
- Absorption
- Distribution
- Elimination
- References
Common side effects when taken by mouth include loss of appetite, vomiting, abdominal pain, and diarrhea. When applied to the skin side effects include itchiness, redness, and blisters. When given by injection there may be fever, liver problems, or hearing loss. Use during breastfeeding appears to be safe. Paromomycin is in the aminoglycoside family of medications and causes bacterial death by stopping the making of protein.
Paromomycin was discovered from Streptomyces krestomuceticus in the 1950s and came into medical use in 1960. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Paromomycin is available as a generic medication. In India the injectable form is about 4.19 to 8.38 pounds for a course of treatment as of 2007. In the United States a typical course of treatment is more than 200 USD as of 2015.
Medical uses
It is an antibiotic used to treat intestinal infections such as cryptosporidiosis and amoebiasis, and other diseases such as leishmaniasis. Paromomycin was demonstrated to be effective against cutaneous leishmaniasis in clinical studies in the USSR in the 1960s, and in trials with visceral leishmaniasis in the early 1990s.
The route of administration is intramuscular injection and capsule. Paromomycin topical cream with or without gentamicin is an effective treatment for ulcerative cutaneous leishmaniasis, according to the results of a phase-3, randomized, double-blind, parallel group–controlled trial.
Pregnancy and breastfeeding
The medication is poorly absorbed. The effect it may have on the baby is still unknown.
There is limited data regarding the safety of taking paromomycin while breastfeeding but because the drug is poorly absorbed minimal amounts of drug will be secreted in breastmilk.
HIV/AIDS
There is limited evidence that paromomycin can be used in persons coinfected with HIV and Cryptosporidium. A few small trials have showed a reduction in oocyst shedding after treatment with paromomycin.
Adverse effects
The most common adverse effects associated with paromomycin sulfate are abdominal cramps, diarrhea, heartburn, nausea, and vomiting. Long-term use of paromomycin increases the risk for bacterial or fungal infection. Signs of overgrowth include white patches in the oral cavities. Other less common adverse events include myasthenia gravis, kidney damage, enterocolitis, malabsorption syndrome, eosinophilia, headache, hearing loss, ringing in the ear, itching, severe dizziness, and pancreatitis.
Interactions
Paromomycin belongs to the aminoglycoside drug class and therefore are toxic to the kidneys and to ears. These toxicities are additive and are more likely to occur when used with other drugs that cause ear and kidney toxicity. Concurrent use of foscarnet increases the risk of kidney toxicity. Concurrent use of colistimethate and paromomycin can cause a dangerous slowing of breathing known as respiratory depression, and should be done with extreme caution if necessary. When used with systemic antibiotics such as paromomycin, the cholera vaccine can cause an immune response. Use with strong diuretics, which can also harm hearing, should be avoided. Paromomycin may have dangerous reactions when used with succinylcholine by increasing the neuromuscular effects.
There are no known food or drink interactions with paromomycin.
Mechanism
Paromomycin is a protein synthesis inhibitor in nonresistant cells by binding to 16S ribosomal RNA. This broad-spectrum antibiotic soluble in water, is very similar in action to neomycin. Antimicrobial activity of paromomycin against Escherichia coli and Staphylococcus aureus has been shown.
Absorption
GI absorption is poor. For IM injection, the absorption is rapid. Paromomycin will reach peak plasma concentration within one hour following an IM injection. The invitro and invivo activities parallel those of neomycin. Anything that impairs GI motility or any obstructions may increase the absorption of the drug. In addition structural damage such as lesions or ulcerations will tend to increase drug absorption.
Distribution
Information not available.
Elimination
Almost 100% of the oral dose is eliminated unchanged via feces; and if there is any absorbed drug, it will be excreted in urine.