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[The role of aminoglycosides in HIV-infected patients]
1Abteilung Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich.
Abstract:
The frequency of serious infections due to Pseudomonas aeruginosa is increasing among patients with advanced HIV infection; most of the cases are community-acquired. Early diagnosis and adequate treatment--usually with the combination of an anti-pseudomonas beta-lactam antibiotic and an aminoglycoside--have a crucial bearing on prognosis. The good in vitro activity of aminoglycosides against mycobacteria contrasts with the need for intravenous administration and toxicity. In patients with Mycobacterium avium complex infection, amikacin should be given only in the event of difficulty with an oral regimen and only on a temporary basis. Similar rules apply to the treatment of multiresistant tuberculosis with streptomycin or amikacin. Paromomycin is not absorbed by the gastrointestinal tract when taken orally, constitutes the treatment of choice against cryptosporidiosis and serves as an alternative against Entamoeba histolytica and Giardia lamblia. Topical treatment with paromomycin ointment can be used in cutaneous leishmaniasis.
Insights
Serious Pseudomonas aeruginosa infections are rising in advanced HIV patients. Early treatment with specific antibiotics is vital, but aminoglycosides have limitations, necessitating careful use in certain mycobacterial infections and parasitic diseases.
Area of Science:
- Infectious Diseases
- Pharmacology
- HIV Medicine
Background:
- Increasing incidence of serious Pseudomonas aeruginosa infections in advanced HIV.
- Community-acquired infections are predominant.
- Prognosis is heavily influenced by early diagnosis and effective treatment.
Purpose of the Study:
- To review the role of aminoglycosides in treating serious infections in advanced HIV.
- To discuss the appropriate use of amikacin and paromomycin in specific opportunistic infections.
- To highlight treatment considerations for Mycobacterium avium complex, tuberculosis, and parasitic infections.
Main Methods:
- Literature review of Pseudomonas aeruginosa and aminoglycoside use in HIV.
- Analysis of treatment guidelines for opportunistic infections.
- Evaluation of in vitro activity and clinical application of amikacin and paromomycin.
Main Results:
- Aminoglycosides combined with beta-lactams are crucial for Pseudomonas aeruginosa infections.
- Amikacin use for Mycobacterium avium complex and multidrug-resistant tuberculosis requires caution due to toxicity and administration route.
- Paromomycin is effective orally for cryptosporidiosis and as an alternative for amebiasis and giardiasis; topical use for cutaneous leishmaniasis.
Conclusions:
- Judicious use of aminoglycosides is essential in managing serious infections in advanced HIV.
- Treatment choices must balance efficacy, toxicity, and route of administration.
- Paromomycin offers specific therapeutic advantages in certain parasitic infections and leishmaniasis.