- Specific Agents:
-
Neomycin
-
Gentamicin
-
Tobramycin
-
Amikacin
- Netilmicin
- Discussion:
- indicated for serious Gm Neg infections caused by suseptable
pseudomonas, proteus,
e. coli,
klebsiella,
enterobacter sp., serratia, and gm neg sepsis;
-
tobramycin is more active than gentamicin against
pseudomonas, including gentamicin-resistant strains, and is usually
indicated over gentamicin for pseudomonas infections, in combination with an antipseudomonal penicillin (AMA, 1983).
- aminoglycocides bind to the bacterial 30s ribosome and inhibit protein synthesis;
- Cautions:
- extended-spectrum penicillins may inactivate
aminoglycosides depending on the
time of exposure and the concentration of penicillin;
- this may occur if both drugs are mixed together in the same bottle, or in vivo in patients with
renal failure in whom high concentrations of penicillin may accumulate.
- arises from nucleophilic attack of the Beta lactam ring on an amino group of aminoglycoside;
-
carbenicillin causes the most inactivation;
- nephrotoxicity and oto-toxicity:
- aminoglycosides are primarily excreted unchanged in the urine
- cumulative doses of these drugs and duration of therapy correlate with the development of oto
and nephrotoxicity, which may result from aminoglycoside accumulation;
- renal insufficiency increases the risk of developing aminoglycoside induced nephrotoxicity;
- when dosing
aminoglycosides after hemodialysis, one should check serum
levels 2 hours after dialysis to allow for redistribution;
- diuretics may increase oto and renal toxicity;
Aminoglycoside therapy. Current use and future prospects.
Nephrotoxicity and ototoxicity of aztreonam versus aminoglycoside therapy in seriously ill nonneutropenic patients.
A model for predicting nephrotoxicity in patients treated with aminoglycosides.
Aminoglycoside dosing in burn patients using first-dose pharmacokinetics.
Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration.
Studies of risk factors for aminoglycoside nephrotoxicity.
Comparative cost effectiveness of gentamicin and tobramycin.
Association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia.
Risk factors for nephrotoxicity in patients treated with aminoglycosides.
The association of aminoglycoside plasma levels with mortality in patients with gram-negative bacteremia.
Risk factors for the development of auditory toxicity in patients receiving aminoglycosides.
Wide interpatient variations in gentamicin dose requirements for geriatric patients.
Can pharmacokinetic dosing decrease nephrotoxicity associated with aminoglycoside therapy.
