Paromisin

Paromisin, more commonly called paromomycin, is an aminoglycoside antibiotic produced by certain Streptomyces species. It is used mainly as a luminal agent to treat parasitic infections of the gastrointestinal tract and is characterized by poor systemic absorption when given orally.

Mechanism of action and pharmacokinetics

Paromomycin binds to the 30S ribosomal subunit in susceptible organisms, interfering with protein synthesis and leading to impaired growth or death of the parasite or microbe. Its oral forms largely remain in the gut, which provides targeted action against intestinal pathogens and minimizes systemic toxicity relative to other aminoglycosides. Because of limited absorption, systemic adverse effects such as ototoxicity and nephrotoxicity are less common with standard oral use, though they can occur if significant absorption takes place or in coexisting renal impairment.

Clinical uses

Paromomycin is used to treat intestinal infections caused by protozoa such as Entamoeba histolytica (amoebiasis) and Giardia lamblia (giardiasis), as well as certain cryptosporidial infections. It is often employed as a luminal agent in combination therapy for amebiasis, after tissue-acting drugs have reduced invasive disease. In addition to intestinal indications, topical paromomycin preparations have been studied and used in some regions for cutaneous leishmaniasis and other skin infections.

Forms and administration

Available formulations include oral tablets or solutions for luminal therapy and topical preparations in some markets. Dosing varies by indication and local guidelines. Because systemic exposure is typically low with oral use, monitoring is focused on gastrointestinal tolerability and potential interactions with other nephrotoxic or ototoxic drugs.

Safety and considerations

Common adverse effects are gastrointestinal upset, including nausea, vomiting, or diarrhea. If significant systemic absorption occurs, or in patients with kidney impairment, the risk of aminoglycoside toxicity increases. Paromomycin should be used during pregnancy only if clearly needed and prescribed by a clinician, with consideration of the limited systemic exposure of the drug.