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A type of bactericidal antibiotic active against some gram positive and most gram negative bacteria. This type of natural antibiotic can be modified for lower human toxicity or greater bacterial activity. Some compounds are also active against protozoa. They act on ribosomal transcription.

Not active vs Pneumococcus or Streptococcus but is active against Staphylococcus. Some eg Tobramycin are effective against Pseudomonas but they are then less effective vs some other gram negatives.

Poor CNS penetration.

Once daily dosing is preferred as it confers a high peak, which gives the best killing (peak/MIC ratio), and also allows for a drug free period. Aminoglycosides need a drug free period to penetrate bacteria - allows adaptive resistance to fall. This is called the post-antibiotic effect, and in practical terms means a low or undetectable trough (less than 0.5). Hartford nomogram gives dosing interval for adults where once daily dosing is too frequent.

Aminoglycosides have a low volume of distribution so obese patients may get toxic if dosed by weight.

Class Contraindications

Class Side-effects

  • Ototoxicity
  • Nephrotoxicity
  • Impairment neuromuscular transmission

Aminoglycoside ototoxicity is associated with a genetic susceptibility in a third to a half of all cases. Most commonly mitochondrial – shows bacterial origin. Screening patients likely to need repeated courses eg CFs, chemotherapy patients, preterm neonates is feasible, but cost:benefit ratio? Consider costs of deafness, cochlear implant etc.

Class Interactions

  • Enhanced ototoxicity with ototoxic diuretics eg furosemide.

Pages in category "Aminoglycosides"

The following 8 pages are in this category, out of 8 total.