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aminoglycoside antibiotic

Indications: 1) life-threatening infections a) endocarditis, especially with prosthetic valves b) synergy with nafcillin against Staphylococcus aureus (benefits obtained in 1st few days of therapy) c) hepatic encephalopathy, hepatic coma [6] d) meningitis 2) empiric therapy of neutropenic patients 3) synergy with penicillins against some Enterococci (obtain in-vitro sensitivities) 4) ancillary agents in treatment of Mycobacterial infections - Mycobacterium avium complex 5) gram-negative organisms a) Campylobacter fetus b) Yersinia enterocolitica c) Pseudomonas aeruginosa [6] d) tularemia e) brucellosis f) plague 6) gram positive infections - Staphylococcus aureus - Listeria monocytogenes - group B Streptococcus 7) skin infections - furunculosis - paronychia - ecthyma gangrenosum 8) otic infections - otitis externa - chronic suppurative otitis media 9) eye infections - keratoconjunctivitis - conjunctivitis - keratitis - blepharoconjunctivitis - meibomitis - dacryocystitis - corneal abrasion, corneal perforation - anterior uveitis 10) intra-abdominal infections - gastrointestinal infections - proctitis - diverticulitis - bacterial peritonitis - cholangitis 11) urogenital infections - gonorrhea - chancroid - urinary tract infection 12) respiratory tract infections - pneumonia 13) infectious arthritis, osteomyelitis 14) sepsis 15) infections in patients with cystic fibrosis [6] 16) infections in patients with burns or necrosis 17) prophylaxis for perioperative infection [6] 18) antibiotic prophylaxis for mastoidectomy 19) empiric treatment for fever of unknown origin [6] Dosage: - once daily dosing preferred Monitor: Therapeutic drug monitoring: - monitor levels - see serum gentamicin, serum amikacin Antimicrobial activity: 1) gram-positive activity (synergy with penicillins) 1) gram-negative activity, including Acinetobacter baumannii, Pseudomonas aeruginosa & carbapenem-resistant Enterobacteriaceae 2) aminoglycosides have no anaerobic activity Adverse effects: 1) ototoxicity a) tinnitus b) vestibular toxicity may occur up to 2-3 months after stopping drug 2) nephrotoxicity a) occurs after 5-7 days of therapy & correlates with the cumulative dose b) often non-oliguric acute tubular necrosis - pigmented or brown granular casts & tubular epithelial cells in the urine sediment. c) urine osmolality is ~300 mOsm/kg H2O d) FENa is >1% e) hypokalemia & hypomagnesemia also can occur due to due to K+ & Mg+2 wasting f) once a day dosing may reduce nephrotoxicity g) even low-dose aminoglycosides may be nephrotoxic [4] Drug interactions: 1) neuromuscular blocking agents: aminoglycosides prolong paralysis 2) aminoglycosides are inactivated with mixed in same IV bag or tubing as penicillins 3) ototoxicity increased by loop diuretics 4) nephrotoxicity increased by coadministration of: a) vancomycin b) amphotericin B c) cyclosporine d) non-steroidal anti-inflammatory drugs [NSAIDs] e) radiocontrast agents Laboratory: - aminoglycoside resistance gene Mechanism of action: 1) bactericidal activity, concentration-dependent 2) ionic cell wall interactions & ribosomal binding

Interactions

drug interactions drug adverse effects of aminoglycosides

Related

aminoglycoside nephrotoxicity aminoglycoside-induced deafness

Specific

amikacin (Amikin) gentamicin (Garamycin, Genoptic, G-Mycin) isepamicin (Exacin) kanamycin (Kantrex) neomycin (Mycifradin) netilmicin (Netromycin) plazomicin (Zemdri) spectinomycin (Trobicin, Actinospectacin) streptomycin tobramycin (Nebcin, Tobrex)

General

aminoglycoside family antibacterial agent

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 597
  4. Cosgrove SE et al. Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic. Clin Infect Dis 2009 Mar 15; 48:713. PMID: 19207079 - Bayer AS and Murray BE Initial low-dose aminoglycosides in Staphylococcus aureus bacteremia: Good science, urban legend, or just plain toxic? Clin Infect Dis 2009 Mar 15; 48:722. PMID: 19207080
  5. Chen LF, Kaye D. Current use for old antibacterial agents: polymyxins, rifamycins, and aminoglycosides. Infect Dis Clin North Am. 2009 Dec;23(4):1053-75, PMID: 19909897
  6. Deprecated Reference