<unk>  is most often used for treating severe infections with multidrug-resistant, aerobic Gram-negative bacteria, especially Pseudomonas, Acinetobacter, Enterobacter, E. coli, Proteus, Klebsiella, and Serratia. The only Gram-positive bacteria that<unk>  strongly affects are Staphylococcus and Nocardia.<unk>  can also be used to treat non-tubercular mycobacterial infections and tuberculosis (if caused by sensitive strains) when first-line drugs fail to control the infection. It is rarely used alone. It is often used in the following situations: * Bronchiectasis * Bone and joint infections * Granulocytopenia, when combined with ticarcillin, in people with cancer * Intra-abdominal infections (such as peritonitis) as an adjunct to other medicines, like clindamycin, metronidazole, piperacillin/tazobactam, or ampicillin/sulbactam * Meningitis: * for meningitis by E. coli, as an adjunct to imipenem * for meningitis caused by Pseudomonas, as an adjunct to meropenem * for meningitis caused by Acetobacter, as an adjunct to imipenem or colistin * for neonatal meningitis caused by Streptococcus agalactiae or Listeria monocytogenes, as an adjunct to ampicillin * for neonatal meningitis caused by Gram negative bacteria such as E. coli, as adjunct to a 3rd-generation cephalosporin * Mycobacterial infections, including as a second-line agent for active tuberculosis. It is also used for infections by Mycobacterium avium, M. abcessus, M. chelonae, and M. fortuitum. * Rhodococcus equi, which causes an infection resembling tuberculosis * Respiratory tract infections, including as an adjunct to beta-lactams or carbapenem for hospital-acquired pneumonia * Sepsis, including that in neonates, as an adjunct to beta-lactams or carbapenem * Skin and suture-site infections * Urinary tract infections that are caused by bacteria resistant to less toxic drugs (often by Enterobacteriaceae or P. aeruginosa)<unk>  may be combined with a beta-lactam antibiotic for empiric therapy for people with neutropenia and fever. Available forms<unk>  may be administered once or twice a day and is usually given by the intravenous or intramuscular route, though it can be given via nebulization. There is no oral form available, as<unk>  is not absorbed orally. In people with kidney failure, dosage must be adjusted according to the creatinine clearance, usually by reducing the dosing frequency. In people with a CNS infection such as meningitis,<unk>  can be given intrathecally (by direct injection into the spine) or intraventricularly (by injection into the ventricles of brain). An liposome inhalation suspension is also available and approved to treat Mycobacterium avium complex (MAC) in the United States. The application for Arikayce was withdrawn in the European Union because the Committee for Medicinal Products for Human Use (CHMP) was of the opinion that the benefits of Arikayce did not outweigh its risks. Special populations<unk>  should be used in smaller doses in the elderly, who often have age-related decreases in kidney function, and children, whose kidneys are not fully developed yet. It is considered pregnancy category D in both the United States and Australia, meaning they have a probability of harming the fetus. Around 16% of<unk>  crosses the placenta; while the half-life of<unk>  in the mother is 2 hours, it is 3.7 hours in the fetus. A pregnant woman taking<unk>  with another aminoglycoside has a possibility of causing congenital deafness in her child. While it is known to cross the placenta,<unk>  is only partially secreted in breast milk. In general,<unk>  should be avoided in infants. Infants also tend to have a larger volume of distribution due to their higher concentration of extracellular fluid, where aminoglycosides reside. The elderly tend to have<unk>  stay longer in their system; while the average clearance of<unk>  in a 20-year-old is 6 L/hr, it is 3 L/hr in an 80-year-old. Clearance is even higher in people with cystic fibrosis. In people with muscular disorders such as myasthenia gravis or Parkinson's disease,<unk> 's paralytic effect on neuromuscular junctions can worsen muscle weakness.
Amikacin
Imipenem
Meropenem
Moxifloxacin
Monobactam
Rifampicin
Resistin
Azithromycin