Upper Limit of Paromomycin Dosing
For paromomycin, the upper limit of dosing is 4 grams per day when used orally for intestinal infections, though specific dosing should be adjusted based on the indication and administration route.
Dosing Guidelines by Indication
Oral Administration (Intestinal Infections)
- Standard oral dosing for adults: 25-35 mg/kg/day divided into 2-4 doses 1
- Maximum oral daily dose: 4 grams (typically as 500 mg four times daily) 1
Parenteral Administration (Visceral Leishmaniasis)
- For visceral leishmaniasis: 15-20 mg/kg/day intramuscularly for 21 days 2
- Higher doses of 20 mg/kg/day have been studied with improved efficacy in certain regions 2
Topical Administration (Cutaneous Leishmaniasis)
- For cutaneous leishmaniasis: 15% paromomycin formulations applied topically 1
- Typical regimen: Apply twice daily for 10 days, rest for 10 days, then reapply twice daily for 10 days 1
Clinical Considerations
Safety Profile
- Paromomycin is an aminoglycoside with activity against Gram-negative bacteria, some Gram-positive bacteria, and certain protozoa 3
- When used orally for intestinal infections, paromomycin has limited systemic absorption, reducing risk of systemic toxicity
- For parenteral administration, monitoring for aminoglycoside-associated toxicity is recommended
Special Populations
- For children: Dosing is typically 25-35 mg/kg/day for intestinal infections 1
- For patients with renal impairment: Dose adjustment may be necessary due to potential nephrotoxicity
Formulation Availability
- Paromomycin is available as 250 mg oral capsules in the US 4
- Topical formulations (15% paromomycin with 12% MBCL ointment or 15% paromomycin with 0.5% gentamicin cream) are used for cutaneous leishmaniasis 1
Important Considerations
- Absorption varies significantly by route of administration
- Topical application results in limited systemic absorption (9-12% of applied dose) 5
- Paromomycin is no longer widely used as an antibiotic but remains important for parasitic infections 3
- For visceral leishmaniasis, combination therapy (e.g., with miltefosine) may be preferred to prevent resistance 6
When prescribing paromomycin, always consider the specific indication, patient factors, and local resistance patterns to determine the optimal dosing regimen within the established upper limit of 4 grams daily for oral administration.