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Aminoglycosides: another perspective
M W Garrison1, D E Zaske, J C Rotschafer
1St. Paul-Ramsey Medical Center, MN.
Abstract:
Despite the introduction of several new classes of antimicrobial agents, aminoglycosides are still recognized as first-line therapeutic agents in the management of severe gram-negative sepsis. The major obstacle limiting the use of aminoglycoside antibiotics has been, and continues to be, the possibility of drug-induced ototoxicity and nephrotoxicity. This review critically examines the definitions used to establish the diagnosis of aminoglycoside-induced nephrotoxicity and ototoxicity and the clinical significance of these adverse reactions. The review also focuses on the practical and economic issues surrounding therapeutic drug monitoring practices. We conclude that aminoglycoside antibiotics remain an effective and economical form of therapy for severe infections and that if careful criteria are used in the selection of these agents, the benefits of therapy outweigh the risk of toxicity.
Insights
Aminoglycoside antibiotics are effective for severe gram-negative sepsis. Careful patient selection and monitoring minimize risks of ototoxicity and nephrotoxicity, making them a valuable treatment option.
Area of Science:
- Pharmacology
- Infectious Diseases
- Toxicology
Background:
- Aminoglycosides remain crucial for severe gram-negative sepsis treatment.
- Ototoxicity and nephrotoxicity are significant limitations of aminoglycoside therapy.
Purpose of the Study:
- To critically review diagnostic criteria and clinical significance of aminoglycoside-induced toxicities.
- To examine practical and economic aspects of therapeutic drug monitoring for aminoglycosides.
Main Methods:
- Literature review focusing on definitions and clinical impact of aminoglycoside toxicity.
- Analysis of therapeutic drug monitoring practices and their economic implications.
Main Results:
- Established diagnostic criteria for aminoglycoside-induced nephrotoxicity and ototoxicity were examined.
- The clinical significance of these adverse reactions was evaluated in the context of severe infections.
Conclusions:
- Aminoglycosides offer effective and economical treatment for severe infections.
- Careful selection and monitoring of aminoglycoside therapy outweigh toxicity risks, supporting their continued use.