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PubMed1984

Comparative study of netilmicin/tinidazole versus netilmicin/clindamycin in the treatment of severe abdominal infections.

The efficacy of netilmicin combined with tinidazole (N + T) or clindamycin (N + C) in the treatment of severe abdominal infections was evaluated in a prospective randomized study with 20 patients in the N + T group and 21 patients in the N + C group. Normally the maintaining dose for netilmicin was 2.25 mg/kg every 12 h, for tinidazole 400 mg every 12 h and for clindamycin 300-600 mg every 6-8 h. The mean duration time of treatment was 8 days in the N + T group and 10 days in the N + C group respectively. In the N + T group 18 patients were cured and in the N + C group 17 patients. Among aerobic bacteria Escherichia coli was most frequently isolated and among anaerobes Bacteroides sp. All aerobic bacteria with 2 exceptions were susceptible to netilmicin and all anaerobic bacteria but 2 to tinidazole or clindamycin. Adequate serum levels were obtained for each antibiotic during therapy. In this study with a small number of patients the combination of netilmicin and tinidazole was as effective as netilmicin and clindamycin.

Adolescent↗

PubMedDate not supplied

Ceftazidime/metronidazole versus netilmicin/metronidazole in the treatment of perforated appendicitis in children.

One hundred children with peritonitis resulting from a perforated appendix were treated with ceftazidime or netilmicin. Metronidazole was added to both groups to treat the anaerobic organisms commonly associated with the infecting aerobic organisms in peritonitis. Escherichia coli was the most common aerobe found in peritoneal pus. Wound infection occurred in nine patients of the netilmicin group and in none treated with ceftazidime (P less than 0.01). No bacterial resistance was evident in the ceftazidime group, but gram-positive streptococci found in eight patients were resistant to netilmicin. Thus it is recommended that an antibiotic of the penicillin group be added if netilmicin is used to treat peritonitis. The results indicate that ceftazidime was more effective than netilmicin in the treatment of children with peritonitis resulting from a perforated appendix.

Appendicitis↗

PubMed1988

[Ceftazidime for the treatment of infections in neutropenic children].

Ceftazidime in doses of 100 mg/kg/day was used, combined with netilmicin 6 mg/kg/day, as first-line treatment in two successive studies conducted on febrile neutropenic children (neutrophils less than 500/mm3). Study n. 1, performed at the Infantile Haematology unit of Saint Louis hospital, Paris, included 75 children. Study n. 2 was a multicentre study involving 88 children from 11 medical centres. The children's age in both studies ranged from 2 months to 16 1/2 years (mean 7 years). The percentage of bacteriologically documented febrile episodes was 45 per cent (34/75 and 39/88), and the most frequent infections were those caused by Gram-positive cocci (56 and 58 per cent respectively of the cases). Vancomycin 40 mg/kg/day was introduced if fever was still present 48 hours after the beginning of the antibiotic therapy. Effective treatments were continued until the neutropenia was corrected. These children were being treated for acute leukaemia, lymphoma, solid tumours or bone marrow aplasia. In study n. 1 apyrexia was obtained in 85 per cent of the cases with the ceftazidime-netilmicin combination and in 91 per cent of the cases after addition of vancomycin. The initial therapy was effective in all patients with a documented infection. There were tow super-infections with septicaemia: one due to Streptococcus D, the other to Staph. epidermidis. In study n. 2 73 per cent of the patients were apyretic after the first combination and 85 per cent after vancomycin was introduced. In proven infections the ceftazidime-netilmicin combination was effective in 30 cases and in another 6 cases after addition of vancomycin. Three patients remained febrile until they came out of aplasia. In all cases the bacterial cultures were sterilized by the ceftazidime-netilmicin combination. There was no superinfection. The mean duration of antibiotic therapy was 21 days in study n. 1 and 14 days in study n. 2. The drugs were perfectly tolerated both clinically and biochemically. No death occurred in the two studies. Thus, owing to its broad spectrum, effectiveness and safety ceftazidime is a very useful antibiotic when combined with netilmicin as first-line treatment of febrile neutropenic children.

Adolescent↗

PubMed1984

Aminoglycoside toxicity - a review of clinical studies published between 1975 and 1982.

The present survey of aminoglycoside nephro- and ototoxicity covers approximately 10,000 patients reported on in clinical trials published between 1975 and 1982. Included in the survey were clinical trials with at least 15 patients evaluable for nephro and/or ototoxicity provided relevant data were given on methodology, patient material and aminoglycoside dosage. Each publication was evaluated by both investigators and relevant data entered into a chart. One hundred and forty-four published trials were surveyed; 139, 63 and 34 for renal, cochlear and vestibular side effects, respectively. Frequencies were calculated as number of patients with side effect of total number of evaluated patients. In the average overall figures toxicity labelled by respective authors as 'definitely', 'probably' and 'possibly' related to study drug is included. When available, frequencies of toxicity 'definitely' and 'probably' related to study drug were analysed separately. The average daily dosages of gentamicin, tobramycin, netilmicin and amikacin were 3.9, 3.8, 5.2 and 15.4 mg/kg, respectively. The average frequencies of nephrotoxicity for gentamicin and tobramycin were 14.0 and 12.9%, respectively, and of netilmicin and amikacin 8.7 and 9.4%, respectively. The average frequency of cochlear toxicity was 13.9% for amikacin, 8.3 and 6.1% for gentamicin and tobramycin, respectively, and 2.4% for netilmicin. The material available for evaluation of vestibular toxicity was considerably smaller. The average frequencies for gentamicin, tobramycin and amikacin were similar (3.2 to 3.7%) while netilmicin again exhibited a somewhat lower figure (1.4%). The overall figures and the clinical ranking that they imply were basically substantiated when prospective comparative trials were analysed separately. However, some inconsistencies go unexplained: for example the frequency of gentamicin nephrotoxicity was markedly higher in trials where it was compared to tobramycin (20 trials) than when it was compared to netilmicin (16 trials).

Aminoglycosides↗

PubMed1984

Induction and inhibition of pinocytosis by aminoglycoside antibiotics.

We investigated whether differences in induction or stimulation of pinocytosis by six amino-glycosides reflected reported differences in their nephrotoxicity. Pinocytosis induced by antibiotics, Na+, K+ or Ca2+ was quantified by the number of pinocytotic channels in Amoeba proteus, a cell suitable for the study of the pinocytotic process. The aminoglycosides were potent inducers of pinocytosis. They were effective in the order of their cationic charge: neomycin greater than gentamicin greater than netilmicin = tobramycin greater than kanamycin greater than streptomycin. Factors which reduced the charge of the molecules, i.e. alkaline pH and combination with carbenicillin or heparin, diminished pinocytosis. Like La3+ the antibiotics inhibited Na+ -induced pinocytosis. The order of efficacy was netilmicin greater than gentamicin greater than neomycin. A similar rank order, which is the reverse of the order of nephrotoxicity, was observed for inhibition of Ca2+ -stimulated, Na+ -induced pinocytosis. Netilmicin was also the most potent inhibitor of the Ca2+-induced pinocytosis in cells treated with concanavalin A. Inhibition of Ca2+ -stimulated pinocytosis by netilmicin was reversed by Ca2+, the calcium ionophore A 23187, or 4-aminopyridine. We have shown that several nephrotoxic cations are strong inducers of pinocytosis in the amoeba, that aminoglycosides in Ringer solution induce pinocytosis in the approximate order of their nephrotoxicity and that factors which are known to diminish toxicity reduce pinocytosis. It, therefore, appears that the mechanism of aminoglycoside nephrotoxicity is related to their ability to induce pinocytosis in the amoeba. Low inducing potency and strong Ca2+ -antagonism, as for netilmicin, are qualities which may reduce the tendency of polycationic compounds to damage proximal tubular cells.

Aminoglycosides↗

PubMed1987

[In vitro sensitivity at 18 antibiotics of 192 strains of Pseudomonas aeruginosa isolated at Garches Hospital].

The in vitro activity of 18 antibiotic (beta-lactam agents, quinolones and aminoglycoside has been evaluated against 192 clinical isolates of Pseudomonas aeruginosa. Minimal inhibitor concentrations (MICs) were determined by the agar dilution technique. The 50% and 90% MICs were respectively: ticarcillin (32/greater than 1 024), azlocillin (16/512), piperacillin (8/512), cefsulodin (4/128), ceftazidime (2/8), aztreonam (4/16), imipenem (2/4), nalidixic acid (128/256), pefloxacin (1/8), norfloxacin (1/8), ofloxacin (2/8), ciprofloxacin (0.25/2), gentamicin (8/256), sisomicin (4/256), tobramycin (2/128) dibekacin (4/256), netilmicin (16/256), amikacin (8/16). The sensitivity to beta-lactam agents and to quinolones was usual. Resistance to aminoglycosides was frequently observed (59%): 35.7% of the resistant isolates were resistant to gentamicin-sisomicin-tobramycin-dibekacin-netilmicin, 30% to netilmicin alone, 17.8% to gentamicin-sisomicin-tobramycin-dibekacin-netilmicin-amikacin, 7% to gentamicin-netilmicin, 5.3% to gentamicin-sisomicin-tobramycin-dibekacin; we did not find any P. aeruginosa resistant only to gentamicin or gentamicin-sisomicin.

Aminoglycosides↗

PubMed1986

Comparative actions of four aminoglycoside antibiotics on the vestibular function in guinea-pigs.

This study was designed to assess the actions of 4 representative aminoglycoside antibiotics on the vestibular functions in guinea-pigs as evidenced by the measurements of the vestibulo-ocular reflex (VOR) either in the horizontal (HVOR) or in the vertical plane (VVOR). VOR responses were evaluated over a wide range of stimulation frequencies prior to and after 10 and 18 days of a multiple dose regimen with dibekacin (150 mg/kg), gentamicin (100 mg/kg), netilmicin (150 mg/kg), tobramycin (100 mg/kg) or saline. All drugs or saline were given intramuscularly twice a day. The labirinthine function was found to be differently impaired by drug administration. Gentamicin induced severe vestibular impairment, which had early onset. Dibekacin greatly reduced all VOR responses, but changes occurred after a longer period of time. Tobramycin and netilmicin induced slight vestibular impairment only after 18 days of treatment. Tobramycin affected both HVOR and VVOR responses at the high frequencies, while netilmicin impaired only the HVOR. Histological examination of vestibular epithelia was conducted by using the Scanning Electron Microscope (SEM). Gentamicin and dibekacin greatly damaged both the cristae of semicircular canals and utriculi, structures which are involved in the generation of VOR responses. Conversely, tobramycin provoked damages only in the cristae of semicircular canals and netilmicin did not affect the vestibular sensory epithelia. These findings indicate that each aminoglycoside produces characteristic actions on the vestibular function which depend on the damage distribution in the labirinthine structures. Among the aminoglycoside examined, netilmicin appears to possess the lowest potential for producing impairment of the vestibular function.

Aminoglycosides↗

PubMed1983

Effectiveness of modified steroid-antibiotic therapies for lethal sepsis in the dog.

Dogs permanently recover (survive at least seven days) from lethal doses of Escherichia coli when treated early with intravenous (IV) intermittent infusions of methylprednisolone sodium succinate and gentamicin sulfate. We evaluated the therapeutic effectiveness of constant or bolus IV infusion of methylprednisolone combined with gentamicin or netilmicin sulfate. Four groups of anesthetized dogs were infused for one hour with E coli and treated as follows (% survival indicated): no treatment (0%); constant infusion of methylprednisolone and gentamicin (100%); bolus infusion of methylprednisolone and gentamicin (57%); and constant infusion of methylprednisolone and netilmicin (83%). Constant or bolus infusion of methylprednisolone was begun 15 minutes after E coli infusion was started. Gentamicin or netilmicin administration was begun when all organisms had been infused. The probability of recovery from shock was significantly increased when dogs were treated with constant infusion of methylprednisolone and intermittent infusions of gentamicin or netilmicin, but was only moderately increased when treated with intermittent bolus infusions of methylprednisolone and intermittent infusions of gentamicin.

Animals↗

PubMedDate not supplied

Effect of peritoneal fluid pH on outcome of aminoglycoside treatment of intraabdominal infections.

Netilmicin and clindamycin were administered to 47 patients with an intraabdominal infection who underwent emergency laparotomy. Thirty-one patients were cured, seven were improved, and therapy failed in nine patients despite the fact that all aerobic bacteria isolated from these patients were sensitive to netilmicin as determined by standard in vitro susceptibility tests. The pH of peritoneal and drainage fluid collected intraoperatively and during follow-up correlated with clinical outcome. Acidic pH was found in 21 of 33 (64%) specimens sampled from patients with therapeutic failure compared to 17 of 80 (21%) obtained from the categories "cured" and "improved" (p < 0.001). Netilmicin concentrations in serum or peritoneal/drainage fluid did not correlate with clinical outcome. Netilmicin levels were above the minimal inhibitory concentration of the pathogens in 59 of 64 (92%) drainage fluid specimens in which aerobic bacteria were isolated. Aerobic bacteria were isolated in 91% of drainage fluid specimens if the pH was less than 7.0, compared to 37% if pH was more than 7.0 (p < 0.001). Reduction of pH antagonized aminoglycoside activity in vitro against clinical isolates of Escherichia coli. Surgical reexploration should be considered in cases of deterioration following a laparotomy associated with detection of acidic drainage fluid.

Abdomen↗

PubMed1993

Studies on drug monitoring in thrice and once daily treatment with aminoglycosides.

OBJECTIVES: To investigate at what time the peak level should be determined under conventional thrice daily (t.i.d.) administration of the aminoglycoside netilmicin and to study its serum concentrations under once daily (od) treatment to define the required daily dose and to gain information about convenient drug monitoring. DESIGN: The design of the study was a consecutive sample trial. SETTING: The study took place in a university hospital. PATIENTS: 41 intubated patients of a surgical ICU who received netilmicin as a short-term infusion over 30 min for life-threatening infections were included in the study. INTERVENTIONS: In 21 patients netilmicin was administered t.i.d. The virtual peak levels which had been determined by pharmacokinetic dosage calculation were compared with the serum concentrations obtained directly after the administration as well as after 15, 30, 60 and 180 min. In 20 patients the netilmicin serum concentrations during od treatment were determined directly before and immediately after the application as well as 0.5, 1, 3, 7 and 12 h later. To achieve a virtual peak level of 25 mg/l and a trough level of 0.5 mg/l individual adjustment of the dosage based on pharmacokinetic calculations was performed. MEASUREMENTS AND RESULTS: In t.i.d. treatment the serum concentration measured after 30 min was closest to the virtual peak level; therefore, this is the best time to determine the peak level. In od treatment the required daily dose was 7.86 mg/kg body weight (median) in patients with normal renal function. During od dosing the trough level was extremely important in drug monitoring, whereas determination of the high peak level was of doubtful value. CONCLUSIONS: The peak level should be determined during t.i.d. administration at 30 min. In od treatment the initial daily dose should be 7 mg/kg body weight; in drug monitoring the trough level is very important.

Adolescent↗

PubMed2001

Postpneumonic empyema in childhood.

Fifty-six patients with postpneumonic empyema were treated by sulbactam/ampicillin or cephalothin and netilmicin. Dose of sulbactam/ampicillin was 200 mg/kg per day and of cephalothin was 200 mg/kg per day, and of netilmicin was 5 mg/kg per day. Sulbactam/ampicillin alone was used in 27 patients. Twenty-nine patients were treated with cephalothin plus netilmicin. Days on intravenous antibiotics, days with chest tube, decortication rate, and duration of hospitalization were significantly shorter in sulbactam/ampicillin treatment group compared to cephalothin plus netilmicin group. This study shows that sulbactam/ampicillin is a safe and effective agent in the treatment of postpneumonic empyema in childhood.

Anti-Bacterial Agents↗

PubMed1986

Choice of drug and dosage regimen. Two important risk factors for aminoglycoside nephrotoxicity.

Since the clinical use of aminoglycosides may be limited by the development of nephrotoxicity, it is important to be aware of those risk factors associated with a greater incidence of renal damage. Some of these factors are related to the drug and its administration and others are related to the patient's clinical condition. In the human kidney, the toxicity mechanism is very likely the same for all aminoglycosides, although the risk of nephrotoxicity increases for a given aminoglycoside as cortical concentrations increase. Kinetic studies in the rat demonstrated a nonlinear increase in renal cortical uptake of gentamicin and netilmicin, a linear relationship for tobramycin uptake, and a mixed kinetic pattern for amikacin, that is, saturation kinetics at low serum concentrations and a linear pattern at high serum levels. At comparable steady-state low serum levels, amikacin and tobramycin showed lower cortical concentrations than gentamicin or netilmicin, demonstrating a lower affinity for the uptake of amikacin and tobramycin in the rat. Since drug uptake kinetics determine the extent of cortical concentrations achieved, dosing strategies may affect cortical accumulation of aminoglycosides. Our kinetic data show that continuous infusions of low doses of gentamicin and amikacin resulted in higher cortical levels, but the differences between regimens were more remarkable for gentamicin than for amikacin. For tobramycin, however, cortical concentrations were similar regardless of the dosing strategy used. In addition, our data show that dosage regimens also determine cortical accumulation in humans. A second major determinant of nephrotoxicity is intrinsic toxicity. At therapeutic doses, gentamicin, tobramycin, netilmicin, and amikacin induce an early lysosomal phospholipidosis in the human kidney cortex comparable to that observed in animals treated with low doses of these drugs. However, animal and human studies have shown that amikacin induces significantly less lysosomal overloading than the other aminoglycosides with no loss of phospholipase A1 activity. Based on the examination of cortical drug levels and the detection of early biochemical and morphologic alterations induced by aminoglycosides, the data suggest that amikacin has less pronounced nephrotoxic effects than gentamicin, netilmicin, or tobramycin, when used in strictly comparable clinical conditions.

Amikacin↗

PubMed1987

Ethics of drug studies in infants: how many samples are required for accurate estimation of pharmacokinetic parameters in neonates?

Our study aimed to determine the least number of samples that are required to obtain accurate pharmacokinetic parameters in neonates. Patients treated with either netilmicin or ceftazidime had between five and eight samples drawn for drug concentration measurement after the first or the last dose of the drug. Pharmacokinetic parameters were calculated using all the available points as a reference and then recalculated with 2, 3, or 4 points. Systemic clearance and volume of distribution were significantly different from the reference value when 2 points were used for netilmicin after the first dose and ceftazidime after the last dose. Had parameters obtained from 2 points been used, mean dosage would have been underestimated by 15% for ceftazidime and 11% for netilmicin, and some patients would have received only 65% of the dose calculated from all available points. When 3 points were used, dosage would have been underestimated by a mean of only 1% for ceftazidime and 5% for netilmicin when compared with the dosage estimated from the reference parameters. We conclude that 3 concentration time points may be all that are required for estimation of pharmacokinetic parameters sufficiently accurate for practical purposes in neonates.

Bacterial Infections↗

PubMed1987

Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: a randomized study.

Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).

Humans↗

PubMed1986

Ciprofloxacin in experimental aortic valve endocarditis due to Pseudomonas aeruginosa.

Left-sided endocarditis caused by Pseudomonas aeruginosa is frequently associated with failure of medical therapy in man. The efficacy of ciprofloxacin and netilmicin + azlocillin has been studied in 79 rabbits with aortic valve endocarditis caused by a serum-resistant strain of P. aeruginosa. Infected animals received either: no therapy; ciprofloxacin (80 mg/kg/day); or netilmicin (6.5 mg/kg/day) + azlocillin (400 mg/kg/day). Ciprofloxacin significantly lowered vegetation titers of P. aeruginosa at days 6 and 10 of therapy compared with netilmicin + azlocillin (P less than 0.001). Similarly, ciprofloxacin was significantly more effective in sterilizing vegetations (P less than 0.005), curing P. aeruginosa endocarditis (P less than 0.001), and preventing bacteriological relapse after discontinuing antibiotic therapy (P less than 0.005). Both antibiotic regimens were equally effective in sterilizing renal abscesses. Resistance to azlocillin was occasionally observed in vivo among P. aeruginosa isolates within cardiac vegetations during the second week of therapy, but not to ciprofloxacin or netilmicin.

Abscess↗

PubMed2005

Can bioimpedance determine the volume of distribution of antibiotics in sepsis?

The relationship between the volume of distribution, assessed according to the two-compartmental pharmacokinetic model, and extracellular water estimated by bioimpedance was studied in mechanically ventilated patients with sepsis and capillary leak. A prospective observational study was performed in a twenty-bed general intensive care unit in the university hospital. Patients received either vancomycin (n = 16) or netilmicin (n = 12) for more than 48 hours. Those with ascites, pleural effusion, on renal replacement therapy or with haemodynamic instability were excluded. Serum concentrations of drugs were taken for pharmacokinetic analysis before, 1 hour and 4 hours after the 30 minute infusion. Bioimpedance measurement was performed at the time of the third sampling. The protocol was repeated after 24 hours. Fluid balance during the 24 hour interval was recorded. Extracellular water was increased and represented 45.6 to 46.6% of total body water Fluid balance correlated with the change of extracellular water (r = 0.82, P < 0.0001) and total body water (r = 0.74, P < 0.0001). Volumes of distribution of vancomycin (0.677 +/- 0.339 l/kg) and netilmicin (0.505 +/- 0.172 l/kg) were increased compared to normal values. A correlation was demonstrated between volume of distribution (Vd(area)) of vancomycin and extra cellular water/total body ratio (r = 0.70, P < 0.0001). The central compartment distribution volume (V1) of netilmicin correlated with extracellular water/total body water ratio (r = 0.60, P < 0.003). Serum concentrations above the recommended therapeutic range were detected in 81.2% of patients on vancomycin and in 50% of patients on netilmicin. Increased volumes of distribution can be estimated by the bioimpedance measurements but are not associated with requirements for higher dosage of the glycopeptide or aminoglycoside antibiotics.

Anti-Bacterial Agents↗

PubMed1986

Comparative effects of aminoglycosides on renal cortical and urinary phospholipids in the rat.

We examined the relationship between the nephrotoxicity potential of four aminoglycosides and the capacity of the drugs to induce a renal cortical phospholipidosis. Sprague-Dawley rats were injected subcutaneously with neomycin, gentamicin, tobramycin, or netilmicin, 100 mg/kg per day, for 1 to 4 days, and phospholipid accumulation in the renal cortex and phospholipid excretion in the urine were measured. The rank order of the drug-induced renal cortical phospholipidosis was netilmicin greater than tobramycin greater than gentamicin greater than neomycin. This order is the reverse of the previously established nephrotoxicity potentials of these drugs. Conversely, the rank order according to peak urinary excretion of phospholipids was gentamicin greater than neomycin greater than tobramycin greater than netilmicin. The rank order of the total urinary phospholipid excretion during the 4 days of the study was neomycin greater than or equal to gentamicin greater than tobramycin greater than or equal to netilmicin. Urinary phospholipid excretion may prove to be a sensitive indicator of aminoglycoside nephrotoxicity.

Aminoglycosides↗

PubMed1989

[Susceptibility of clinically-isolated problem pathogenic bacteria to broad spectrum antibiotics].

The action of broad-spectrum antibiotics investigated by disc diffusion method on 636 problem bacteria such as S. aureus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Proteus that isolated from various clinical specimens. The highest and lowest ratio of susceptibility were as follows: S. aureus were found sensitive 90% to Netilmicin, 27% to Piperacillin, Enterobacter species 78% to Netilmicin, 25% to Piperacillin, Klebsiella 69% to Amikacin, 20% to Piperacillin, Pseudomonas 66% to Amikacin, 5% to Amoxicillin-Clavulanic acid, E.coli 68% to Netilmicin and Ceftriaxone, 32% to Piperacillin, Proteus 70% to Netilmicin, 43% to Piperacillin, S.epidermidis 90% to Amoxicillin-Clavulanic acid, 60% to Piperacillin.

Amikacin↗