{"id":4189,"date":"2013-06-06T16:05:28","date_gmt":"2013-06-06T20:05:28","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4189"},"modified":"2015-06-04T14:33:31","modified_gmt":"2015-06-04T18:33:31","slug":"id-learning-unit-aminoglycosides","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/id-learning-unit-aminoglycosides\/2013\/06\/06\/","title":{"rendered":"ID Learning Unit — Aminoglycosides"},"content":{"rendered":"

\"\"<\/a>You young whippersnappers out there may not believe it, but we once used aminoglycosides\u00a0all the time — <\/em>literally every day on inpatient medical and surgical services, especially in the ICUs.<\/p>\n

They were an inevitable part of “triples” (e.g., amp\/gent<\/strong>\/clinda), a broad-spectrum combination given to almost every critically ill patient way back when — think right around the time Pac-Man was state-of-the-art and George Bush Senior<\/em> was President, saying he didn’t like\u00a0broccoli.<\/p>\n

(It’s just an association with the 1980s\/early 1990s I’m after. How’d I do?)<\/p>\n

Over the years, aminoglycoside prescribing has rapidly and progressively declined — there are other less toxic antibiotics that do the same thing — so these drugs are unfamiliar to many clinicians today.<\/p>\n

But they still have their place, so here is brief refresher unit.<\/p>\n

Let’s start with a table comparing the four agents in most common use, and finish with some factoids that could be clinically relevant — or at the very least quite helpful when trying to impress your friends. First, the table:<\/p>\n

 <\/p>\n\n\n\n\n\n\n\n
Drug<\/strong><\/td>\nPrincipal Indication<\/strong><\/td>\nDistinguishing Characteristic Compared with Others<\/strong><\/td>\n<\/tr>\n
Gentamicin<\/strong><\/td>\nUsed in combination with ampicillin or penicillin or vancomycin for treatment of serious infections due to enterococcal (and some streptococcal) infections.<\/td>\nLeast expensive.<\/td>\n<\/tr>\n
Tobramycin<\/strong><\/td>\nUsed as inhalational therapy in patients with cystic fibrosis, bronchiectasis, and other conditions associated with recurrent bacterial respiratory tract infections.<\/td>\nMost active in vitro<\/em> versus Pseudomonas aeruginosa.<\/em><\/td>\n<\/tr>\n
Amikacin<\/strong><\/td>\nUsed as part of empiric broad therapy in patients with known highly resistant GNR infections, or in urinary tract infections with no oral alternatives.<\/td>\nBroadest antibacterial spectrum.<\/td>\n<\/tr>\n
Streptomycin<\/strong><\/td>\nUsed as part of second-line combination therapy for tuberculosis and other mycobacterial infections.<\/td>\nVestibular toxicity a particular problem.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Now for the factoids:<\/p>\n