Serious Gram Negative Bacillary Infections

Gentamicin is the aminoglycoside antibiotic most commonly used to treat serious infections due to gramnegative aerobic bacilli, such as Escherichia coli and Klebsiella pneumoniae, and Proteus, Serratia, Acinetobacter, Citrobacter, and Enterobacter spp. Gentamicin also has significant activity against Staphylococcus aureus. The aminoglycosides are often used in combination with p-lactams in the initial empirical therapy of sepsis and of fever in immunocompromised patients. The combination is used both to ensure adequate antibiotic coverage in these seriously ill patients and to exploit the synergistic antibiotic activity that p-lactams and aminoglycosides have against many species. These drugs should not, however, be injected simultaneously, since the p-lactams can chemically inactivate the aminoglycosides.

Aminoglycosides are often used in patients with gram-negative bacillary pneumonia. Single daily dosing may be of particular importance in patients with pneumonia, since this regimen can increase the peak concentration of the aminoglycosides in bronchial secretions.

Acute salpingitis (pelvic inflammatory disease) due to Neisseria gonorrhoeae, Chlamydia trachomatis, or both is often complicated by superinfection with gramnegative bacilli and anaerobes. A combination of gen-tamicin, clindamycin, and doxycycline has been shown to be an effective treatment for this polymicrobial infection.

The combination of gentamicin and clindamycin is useful in patients with an intraabdominal infection or an abscess secondary to penetrating trauma, diverticuli-tis, cholangitis, appendicitis, peritonitis, or postsurgical wound infection. These infections are often polymicro-bial, including gram-negative bacilli and anaerobes. Definitive treatment of these conditions may also require surgical or other intervention to drain the abscess.

Choice of one aminoglycoside over another for the treatment of serious infections should be guided both by assessment of the antibiotic sensitivities of the spe cific bacterial strain causing the patient's infection and by familiarity with local patterns of bacterial resistance. Pseudomonas aeruginosa is more likely than other gram-negative bacilli to exhibit resistance to genta-micin. However, Pseudomonas spp. resistant to gen-tamicin may be susceptible to amikacin or tobramycin. Streptomycin is the drug of choice for patients with pneumonia due to Yersinia pestis (plague) or Francisella tularensis (tularemia).

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