II. Indications
- Activity
- Aerobic and facultative Gram Negative Rods
- NO anaerobic activity
- Aminoglycosides require oxygen for active transport into Bacterial cells
- Organisms
III. Mechanism
- Bactericidal, Protein Synthesis Inhibitor
- Antibiotic Resistance mechanisms
IV. Medications: Active
- Amikacin
- Gentamicin
- Plazomycin
- Streptomycin
- Tobramycin
V. Medications: Other
- Kanamycin
- Kanamycin is not typically used in U.S., however, Amikacin is derived from Kanamycin A
- Kanamycin is an Antibiotic complex extracted from Streptomyces kanamyceticus (found in Japanese soil)
- Kanamycin complex has three components (A, B, C) of which only Kanamycin A has significant medical use
VI. Pharmacokinetics
- Renal excretion unchanged in urine
- Not distributed to the eye or Central Nervous System
-
Parenteral use, inhaled (Tobramycin in CF) or topical use (otic Antibiotics, Ophthalmic Antibiotics)
- Aminoglycosides have no significant oral Bioavailability (other than Kanamycin)
VII. Adverse Effects
- Nephrotoxicity
- See risk factors below
-
Ototoxicity
- Risk of permanent Deafness
- With higher Aminoglycoside peak concentrations
- Increased risk in Mitochondrial DNA mutations (e.g. m.1555A>G)
-
Neuromuscular Blockade
- May increase Neuromuscular Blocker effect
- May exacerbate Myasthenia Gravis
VIII. Risk Factors: Nephrotoxicity
- Advanced age
- Prior Renal Insufficiency
- Dehydration
- Hypokalemia
- Hypomagnesemia
- Liver disease
- Sepsis
-
Drug Interactions with other nephrotoxic medications
- Cephalothin (Keflin) and other Cephalosporins
- Cyclosporin A
- Cisplatin
- NSAIDS
- ACE Inhibitors
- Methoxyflurane
- Loop Diuretics
- Amino Acids
IX. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 112-3
- Block (2023) Aminoglycosides, StatPearls, Treasure Island, Fl