Aminoglycosides are useful for severe respiratory tract infections

Clinical trials comparing the efficacy of monotherapy with aminoglycosides versus beta-lactams suggest that standard multiple-daily dosing regimens of aminoglycosides are less effective than the newer broad-spectrum beta-lactams, especially against Pseudomonas aeruginosa. However, the addition of an aminoglycoside to a beta-lactam has increased survival in patients with gram-negative bacteremia, particularly in those with hypotension and severe illness. This reduction in mortality has not yet been observed with other popular combinations, such as the fluoroquinolones with beta-lactams. The ability of aminoglycosides to prevent the emergence of resistance is less well documented. Newer studies on the pharmacodynamics of antimicrobials have shown that once-daily dosing optimizes the efficacy and minimizes the toxicities of aminoglycosides. Meta-analyses of large numbers of clinical trials have suggested that this method of drug administration can facilitate the increased usage of the aminoglycosides while limiting nephrotoxicity and the cost of antimicrobial therapy. The use of aminoglycosides by once-daily dosing for adjunctive therapy in severe respiratory tract infections is both efficacious and safe.