AMINOGLYCOSIDES
Aminoglycosides are potent, broad-spectrum antibiotics that act through
inhibition of protein synthesis. The class has been a cornerstone of
antibacterial chemotherapy. Aminoglycosides are potent bactericidal
antibiotics that act by creating fissures in the outer membrane of the
bacterial cell. They are particularly active against aerobic, gram-negative
bacteria and act synergistically against certain gram-positive organisms.
Examples of aminoglycosides include:
Gentamicin: The most commonly used aminoglycoside
Tobramycin: An aminoglycoside used to treat bacterial infections
Amikacin: An aminoglycoside used to treat bacterial infections
Neomycin: An aminoglycoside
Streptomycin: An aminoglycoside
Plazomicin: An aminoglycoside
Mechanism of action:
Aminoglycosides are potent bactericidal antibiotics that act by creating
fissures in the outer membrane of the bacterial cell. They are particularly
active against aerobic, gram-negative bacteria and act synergistically
against certain gram-positive organisms.
Route:
Depending on the aminoglycoside chosen, the administration can be
oral, parenteral, inhalation, intraperitoneal, or intraventricular.
Dose:
If a patient is below their ideal body weight (IBW), their total body
weight (TBW) should be used to calculate doses. If TBW is greater than
IBW but less than 120% of IBW, dosing should be based on IBW. If
TBW is greater than 120% of IBW, adjusted body weight (ABW) should
be used to calculate doses:
IBW in kg (males): 50 + (2.3 × inches above 60 inches)
IBW in kg (females): 45.5 + (2.3 × inches above 60 inches)
ABW in kg: IBW + [0.4 × (TBW – IBW)]
In patients with normal renal function, once/day dosing is
Gentamicin or tobramycin: 5 mg/kg (7 mg/kg if patients are critically ill)
every 24 hours
Amikacin: 15 mg/kg every 24 hours
If patients respond to the 7-mg/kg dose
of gentamicin or tobramycin clinically and renal function continues to be
normal, the once/day dose can be reduced to 5 mg/kg after the first few
days of treatment.
Indications:
Serious gram-negative bacillary infections
Septicemia
Meningitis
Pelvic and abdominal sepsis
Bacterial endocarditis
Tuberculosis
Plague.
Contraindications:
Aminoglycosides are contraindicated in patients who are allergic to
them.
Pregnancy
Lactation
Side effects:
Buzzing noise in the ears
Dizziness
Muscle weakness and spasms
Headache
Nausea and vomiting
Adverse Effects:
Dizziness,
Vertigo,
Tinnitus,
Roaring in the ears and also
Hearing loss
Toxicity:
Kidney Injury,
Hearing Impairment
Vestibular Toxicity.
Drug Interactions:
Interacts with penicillin to lower the activity of penicillin.
Carbenicillin and ticarcillin reduce the effects of amikacin,
gentamicin, kanamycin, neomycin, streptomycin, and tobramycin.
When giving penicillin with aminoglycosides, penicillin should be
given first and separately.
If amikacin, gentamicin, kanamycin, neomycin, streptomycin, and
tobramycin are administered with neuromuscular blockers, the
neuromuscular blockade increases, which results in increased muscle
relaxation and respiratory distress. Therefore, one must exercise
caution if the patient has to undergo anesthesia and is taking
aminoglycosides.
Nursing Responsibility:
If any signs or symptoms of decreased renal function in the patient
or decreased hearing ability is present, inform the healthcare
provider promptly.
Hydrate the patient well to avoid a chemical reaction in the renal
tubes.
Check the expiration date before the administration of the drug.
Follow the manufacturer’s instructions for the reconstitution,
dilution, and storage of drugs.
Rapid IV administration can cause neuromuscular blockade;
therefore, infuse the drug continuously or intermittently for over 30
to 60 minutes for adults and over 1 to 2 hours for infants.
However, dilution volume for children is determined individually.
