Aminoglycosides are bactericidal agents which bind to bacterial ribosomes. They are active against the Enterobacteriaceae and staphylococci. They are synergistic in combination with penicillins except when there is high-level resistance. Penetration into the lung is poor but they are well concentrated in the urine. Their use is limited by nephrotoxicity and ototoxicity, and other agents should be used where possible. Serum concentrations have to be assayed daily in the ICU to avoid potential toxicity. Individual dosing based on daily assays is best practice. A course should be up to 3 to 5 days, and longer courses should only be used exceptionally (e.g. endocarditis). In patients with normal renal function, administration of a large single daily dose (7 mg/kg) has been found to reduce toxicity without affecting efficacy (Nicolau et...M.: 1995). A single assay is taken 6 to 14 h after the dose to determine the next dosage interval. Aminoglycosides are used in severe infections, particularly those acquired in hospital, when resistance to penicillins or cephalosporins is likely. Amikacin can be used in gentamicin-resistant infections.
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