BSN Tracker

plazomicin

Brand: Zemdri

⚠ BBW TDM Required Prototype: gentamicin
Drug Class: aminoglycoside antibiotic
Drug Family: antibiotic
Subclass: next-generation aminoglycoside (resistant to most aminoglycoside-modifying enzymes)
Organ Systems: infectious-disease

Mechanism of Action

Semi-synthetic aminoglycoside derived from sisomicin with substitutions that protect against the six most common aminoglycoside-modifying enzymes (AMEs); retains activity against CRE and many organisms resistant to all other aminoglycosides.

30S ribosomal subunit

Indications

  • complicated urinary tract infections (cUTI) and acute pyelonephritis due to Enterobacteriaceae including CRE

Contraindications

  • aminoglycoside hypersensitivity
  • pregnancy

Adverse Effects

Common

  • decreased renal function
  • diarrhea
  • headache
  • hypertension

Serious

  • nephrotoxicity
  • ototoxicity
  • neuromuscular blockade

Pharmacokinetics (ADME)

Absorption IV only
Distribution extracellular distribution; low protein binding
Metabolism not metabolized
Excretion renal (unchanged)
Half-life 3.5 hours
Onset immediate (IV)
Peak end of infusion
Duration 24 hours (once-daily dosing)
Protein Binding <20%
Vd low-moderate

Drug Interactions

Drug / Agent Mechanism Severity
loop diuretics additive ototoxicity major
nephrotoxic agents additive nephrotoxicity major

Nursing Considerations

  1. Administer IV over 30 minutes once daily; use pharmacokinetic/pharmacodynamic principles for dose optimization in renal impairment.
  2. Monitor serum creatinine, BUN, and urine output throughout therapy; dose adjustment required if renal function changes.
  3. Assess for audiological symptoms (tinnitus, hearing loss) and vestibular symptoms (dizziness, vertigo) and report immediately.
  4. Reserved for CRE cUTI when other options are limited; confirm susceptibility before use.

Clinical Pearls

  • Plazomicin's chemical modifications confer resistance to acetyl-, adenyl-, and phosphoryl-transferases that inactivate gentamicin and tobramycin, making it active against most AME-producing CRE.
  • It is FDA-approved only for cUTI, limiting its use; combination regimens with colistin or meropenem are being studied for systemic CRE infections.

Safety Profile

Pregnancy use-with-caution
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Required
Guideline Update pending

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Aminoglycoside Antibiotic Complicated Urinary Tract Infections (cUTI) And Acute Pyelonephritis Due To Enterobacteriaceae Including CRE
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