A natural group of three aminoglycosides from Streptomyces fradiae isolated first in 1949 it is effective against both gram positive and gram negative bacteria. It has high human systemic toxicity.
Poorly absorbed so widely used for gut sterilisation or topically.
- 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.
- Enhanced ototoxicity with ototoxic diuretics eg furosemide.