aminoglycoside antibiotic
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Indications
- life-threatening infections
- endocarditis, especially with prosthetic valves
- synergy with nafcillin against Staphylococcus aureus (benefits obtained in 1st few days of therapy)
- hepatic encephalopathy, hepatic coma[6]
- meningitis
- empiric therapy of neutropenic patients
- synergy with penicillins against some Enterococci (obtain in-vitro sensitivities)
- ancillary agents in treatment of Mycobacterial infections
- gram-negative organisms
- gram positive infections
- skin infections
- otic infections
- eye infections
- intra-abdominal infections
- urogenital infections
- respiratory tract infections
- infectious arthritis, osteomyelitis
- sepsis
- infections in patients with cystic fibrosis[6]
- infections in patients with burns or necrosis
- prophylaxis for perioperative infection[6]
- antibiotic prophylaxis for mastoidectomy
- empiric treatment for fever of unknown origin[6]
Dosage
- once daily dosing preferred
Monitor
- monitor levels
- see serum gentamicin, serum amikacin
Antimicrobial activity
- gram-positive activity (synergy with penicillins)
- gram-negative activity, including Acinetobacter baumannii, Pseudomonas aeruginosa & carbapenem-resistant Enterobacteriaceae
- aminoglycosides have no anaerobic activity
Adverse effects
- ototoxicity
- tinnitus
- vestibular toxicity may occur up to 2-3 months after stopping drug
- nephrotoxicity
- occurs after 5-7 days of therapy & correlates with the cumulative dose
- often non-oliguric acute tubular necrosis
- pigmented or brown granular casts & tubular epithelial cells in the urine sediment.
- urine osmolality is ~300 mOsm/kg H2O
- FENa is >1%
- hypokalemia & hypomagnesemia also can occur due to due to K+ & Mg+2 wasting
- once a day dosing may reduce nephrotoxicity
- even low-dose aminoglycosides may be nephrotoxic[4]
Drug interactions
- neuromuscular blocking agents: aminoglycosides prolong paralysis
- aminoglycosides are inactivated with mixed in same IV bag or tubing as penicillins
- ototoxicity increased by loop diuretics
- nephrotoxicity increased by coadministration of:
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Laboratory
Mechanism of action
- bactericidal activity, concentration-dependent
- ionic cell wall interactions & ribosomal binding
More general terms
More specific terms
- amikacin (Amikin)
- gentamicin (Garamycin, Genoptic, G-Mycin)
- isepamicin (Exacin)
- kanamycin (Kantrex)
- neomycin (Mycifradin)
- netilmicin (Netromycin)
- plazomicin (Zemdri)
- spectinomycin (Trobicin, Actinospectacin)
- streptomycin
- tobramycin (Nebcin, Tobrex)
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 597
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/19207080 - ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/19909897
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Deprecated Reference