Paromomycin

Structural formula
General
Non-proprietary name	Paromomycin
other names	Latin : Paromomycinum; IUPAC : (2 R , 3 S , 4 R , 5 R , 6 S ) -5-amino-6 - [(1 R , 2 S , 3 S , 4 R , 6 S ) -4,6-diamino-2 - [(2 S , 3 R , 4 R , 5 R ) -4 - [(2 R , 3 R , 4 R , 5 R , 6 S ) -3-amino-6- (aminomethyl) -4,5- dihydroxy-oxan-2-yl] oxy-3-hydroxy-5- (hydroxymethyl) oxolan-2-yl] oxy-3-hydroxy-cyclohexyl] oxy-2- (hydroxymethyl) oxane-3,4-diol;
Molecular formula	C 23 H 45 N 5 O 14
Brief description	white powder (sulfate)
External identifiers / databases
ECHA InfoCard	100,028,567
PubChem	165580
DrugBank	DB01421
Wikidata	Q415625
Drug information
ATC code	A07 AA06
Drug class	Aminoglycoside antibiotics
properties
Molar mass	615.63 g · mol -1
Physical state	firmly
solubility	easily in water
safety instructions
	Please note the exemption from the labeling requirement for drugs, medical devices, cosmetics, food and animal feed
GHS labeling of hazardous substances	no GHS pictograms
	no GHS pictograms
H and P phrases	H: no H-phrases
	P: no P-phrases
Toxicological data	156 mg kg −1 ( LD 50 , rat , iv )
	As far as possible and customary, SI units are used. Unless otherwise noted, the data given apply to standard conditions .

Paromomycin (trade name: Humatin ^® ) is an aminoglycoside antibiotic that is used to treat infections in the digestive tract . Paromomycin is a very old antibiotic that has recently taken on new meaning in the treatment of leishmaniasis . It is very similar to the aminoglycoside antibiotic neomycin .

Mechanism of action

Paromomycin, like most aminoglycoside antibiotics, works by inhibiting bacterial protein synthesis by attaching the antibiotic to the 30S subunit of the bacterial ribosomes . Paromomycin is effective against gram-negative and gram-positive bacteria as well as amoebas and tapeworms in the intestine. Orally given paromomycin is not absorbed . Paromomycin is obtained from Streptomyces rimosus .

Areas of application

Paromomycin has long been used for the prophylaxis and treatment of hepatic encephalopathy by greatly reducing the ammonia-forming intestinal flora and relieving the liver, also for the preoperative reduction of the intestinal flora and finally for the treatment of tapeworms and amoebic dysentery . Paromomycin in the form of capsules to be taken orally is approved in many countries for these areas of application.

Paromomycin administered by intramuscular injection (IM) has been tested in Phase III clinical trials in India for the treatment of visceral leishmaniasis over the past few years by the American non-profit Institute for OneWorld Health . Paromomycin IM was shown to be no less effective than the comparative drug amphotericin B and has now also been approved for this indication in India. The World Health Organization added Paromomycin IM to its Essential Medicines List in 2007. In the United States and Europe, OneWorld Health received orphan drug status for paromomycin IM for the treatment of leishmaniasis ; however, approval has not yet been obtained.

In cats, the active ingredient has been used successfully for cryptosporidiosis , but due to possible kidney failure there is no general therapy recommendation.

Contraindications and side effects

Paromomycin must not be given in the case of known hypersensitivity to aminoglycoside antibiotics, severe renal insufficiency , intestinal obstruction and myasthenia gravis . Paromomycin should also not be used during pregnancy and breastfeeding.

The most common oral side effect is diarrhea; injection site pain has been observed very commonly with intramuscular injection.

Individual evidence

↑ ^a ^b Data sheet Paromomycin Sulfate (PDF) from Calbiochem, accessed on December 8, 2015.
↑ ^a ^b Data sheet Paromomycin sulfate salt from Sigma-Aldrich , accessed on May 9, 2017 ( PDF ).
↑ Entry on paromomycin in the ChemIDplus database of the United States National Library of Medicine (NLM) .
↑ Red List online, as of October 2009.
↑ AM comp. d. Switzerland, as of October 2009.
↑ AGES-PharmMed, as of October 2009.
^ P. Sundar, TK Jha, CP Thakur, PK Sinha, SK Bhattacharya: Injectable paromomycin for Visceral leishmaniasis in India. In: The New England Journal of Medicine . Volume 356, Number 25, June 2007, pp. 2571-2581, doi : 10.1056 / NEJMoa066536 , PMID 17582067 .
^ Dwight D. Bowman, Charles M. Hendrix, David S. Lindsay, Stephen C. Barr: Feline Clinical Parasitology. John Wiley & Sons, 2008, ISBN 978-0-470-37659-1 , pp. 7-8.

[Merck-1] Data sheet Paromomycin Sulfate (PDF) from Calbiochem, accessed on December 8, 2015.

[Sigma-2] Data sheet Paromomycin sulfate salt from Sigma-Aldrich , accessed on May 9, 2017 ( PDF ).

[ChemIDplus-3] Entry on paromomycin in the ChemIDplus database of the United States National Library of Medicine (NLM) .

[4] Red List online, as of October 2009.

[5] AM comp. d. Switzerland, as of October 2009.

[6] AGES-PharmMed, as of October 2009.

[7] P. Sundar, TK Jha, CP Thakur, PK Sinha, SK Bhattacharya: Injectable paromomycin for Visceral leishmaniasis in India. In: The New England Journal of Medicine . Volume 356, Number 25, June 2007, pp. 2571-2581, doi : 10.1056 / NEJMoa066536 , PMID 17582067 .

[8] Dwight D. Bowman, Charles M. Hendrix, David S. Lindsay, Stephen C. Barr: Feline Clinical Parasitology. John Wiley & Sons, 2008, ISBN 978-0-470-37659-1 , pp. 7-8.