Efficacy is diminished and risk of ototoxicity increased in patients with hypoproteinemia (associated with nephrotic syndrome); ototoxicity is associated with rapid injection, severe renal impairment, use of higher than recommended doses, concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs.
www.phac-aspc.gc.ca. The Public Health Agency of Canada (French: Agence de la santÃ© publique du Canada) is an agency of the Government of Canada that is responsible for public health, emergency preparedness, and response and infectious and chronic disease control and prevention.
Globally, Canada was at the forefront of the public health approach with the 1974 Federal publication of New Perspectives on the Health of Canadians by then Minister of Health Marc Lalonde.