Aminoglycosides are a class of antibiotics that are used to treat serious infections caused by bacteria that are difficult to treat. Aminoglycosides are called bactericidal antibiotics because they kill bacteria directly. They achieve this by halting the production of essential proteins in bacteria, crucial for their survival.
Aminoglycosides are particularly active against aerobic, gram-negative bacteria and some gram-positive bacteria, such as Staphylococci and Mycobacterium tuberculosis. They are often used in combination with other antibiotics to enhance their effectiveness and prevent resistance. Aminoglycosides are not well absorbed when given by mouth, so they need to be given by injection by healthcare personnel.
Aminoglycosides have a narrow margin between a safe and a toxic dose, and they can cause serious side effects, such as impairment of kidney function and hearing loss. Therefore, they are usually reserved for cases where other less toxic antibiotics are contraindicated or ineffective. Aminoglycosides are also used as topical agents for eye, ear, and skin infections.
Aminoglycosides Mechanism of Action
Aminoglycosides work by binding to the bacterial ribosomes, which are the structures that make proteins from the genetic information in the bacterial DNA. Aminoglycosides interfere with the accuracy and efficiency of the protein synthesis process, leading to the production of faulty or incomplete proteins.
These defective proteins can have various effects on the bacterial cell, such as disrupting the cell membrane, impairing the enzyme activity, or triggering the immune system. As a result, the bacterial cell dies or becomes more susceptible to other antibiotics or the host defense mechanisms.
Aminoglycosides have a concentration-dependent killing effect, which means that the higher the concentration of the drug, the faster and more complete the bacterial killing is. This also means that aminoglycosides can be given in a single daily dose, which increases the safety window and reduces the risk of toxicity.
Aminoglycosides are effective against a wide range of bacteria, but they also face some limitations, such as bacterial resistance, poor penetration into some tissues, and incompatibility with some other drugs. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider.
Types of Aminoglycosides
Overview of Common Aminoglycoside Drugs
Aminoglycosides are a diverse group of antibiotics that share some common features, such as containing amino sugars linked by glycosidic bonds. However, they also differ in their chemical structures, spectra of activity, pharmacokinetics, and adverse effects.
Some of the most commonly used aminoglycoside drugs are:
Gentamicin: A broad-spectrum antibiotic that is effective against many gram-negative bacteria, such as Escherichia coli, Klebsiella, Proteus, Pseudomonas, and Serratia. It is also active against some gram-positive bacteria, such as Staphylococcus aureus and Enterococcus. Gentamicin is often used in combination with other antibiotics, such as penicillins, cephalosporins, or vancomycin, to treat serious infections, such as septicemia, endocarditis, osteomyelitis, and urinary tract infections. Gentamicin is available as an injection, an eye drop, or an ear drop.
Tobramycin: A similar antibiotic to gentamicin, but with a narrower spectrum of activity. It is mainly used to treat infections caused by Pseudomonas aeruginosa, a common cause of hospital-acquired infections, especially in patients with cystic fibrosis, burns, or immunosuppression. Tobramycin is also available as an injection, an eye drop, or an ear drop. In addition, it can be administered by inhalation to treat respiratory infections in cystic fibrosis patients.
Amikacin: A semi-synthetic derivative of kanamycin, another aminoglycoside. It has a broader spectrum of activity than gentamicin and tobramycin and is more resistant to bacterial enzymes that inactivate aminoglycosides. It is effective against many gram-negative bacteria, such as Acinetobacter, Citrobacter, Enterobacter, and Providencia, as well as some gram-positive bacteria, such as Staphylococcus and Streptococcus. Amikacin is also used to treat infections caused by Mycobacterium tuberculosis, the bacterium that causes tuberculosis. Amikacin is only available as an injection.
Streptomycin: The first aminoglycoside discovered, and the only one that does not contain a deoxystreptamine ring in its structure. It has a narrow spectrum of activity and is mainly used to treat infections caused by Mycobacterium tuberculosis and Mycobacterium leprae, the bacteria that cause tuberculosis and leprosy, respectively. Streptomycin is also used to treat plague, tularemia, and brucellosis, which are rare but serious infections caused by Yersinia pestis, Francisella tularensis, and Brucella spp., respectively. Streptomycin is only available as an injection.
Varieties and Their Characteristics
Aminoglycosides can be classified into different varieties based on their chemical structures and their modes of action. The main varieties are:
2-Deoxystreptamine (2-DOS) aminoglycosides: These are the most common and diverse group of aminoglycosides, and include gentamicin, tobramycin, amikacin, kanamycin, neomycin, and paromomycin. They all contain a 2-DOS ring, which is a six-membered ring with two amino groups, attached to one or two other sugar rings. The 2-DOS ring is essential for the binding of these aminoglycosides to the bacterial ribosome, where they interfere with the protein synthesis process. The number and position of the sugar rings determine the spectrum and potency of these aminoglycosides.
Non-2-DOS aminoglycosides: These are aminoglycosides that do not contain a 2-DOS ring, and include streptomycin, spectinomycin, and plazomicin. Streptomycin has a streptidine ring, which is a six-membered ring with one amino group and one nitrogen atom, attached to two other sugar rings. Spectinomycin has a spectinocycline ring, which is a seven-membered ring with one amino group and two nitrogen atoms, attached to one sugar ring. Plazomicin has a hydroxylated 6’-N-aminoglycoside ring, which is a six-membered ring with one amino group and one hydroxyl group, attached to two other sugar rings. These aminoglycosides have different mechanisms of action than the 2-DOS aminoglycosides and are effective against some bacteria that are resistant to the latter.
Aminoglycosides Examples
Gentamicin
Gentamicin is a 4,6-disubstituted 2-DOS aminoglycoside, which means that it has two sugar rings attached to the 4 and 6 positions of the 2-DOS ring. It is composed of three components: gentamicin C1, C1a, and C2. Gentamicin binds to the 30S subunit of the bacterial ribosome, and causes misreading of the genetic code, leading to the production of defective proteins. It also blocks the initiation and elongation of protein synthesis and induces the formation of abnormal polysomes, which are clusters of ribosomes.
Gentamicin is a broad-spectrum antibiotic that is active against many gram-negative bacteria, such as Escherichia coli, Klebsiella, Proteus, Pseudomonas, and Serratia. It is also active against some gram-positive bacteria, such as Staphylococcus aureus and Enterococcus. However, it is not effective against anaerobic bacteria, fungi, or viruses. Gentamicin is often used in combination with other antibiotics, such as penicillins, cephalosporins, or vancomycin, to treat serious infections, such as septicemia, endocarditis, osteomyelitis, and urinary tract infections.
Gentamicin is not well absorbed when given by mouth, so it needs to be given by injection by healthcare personnel. It is usually administered once or twice a day, depending on the severity of the infection and the patient’s kidney function. The dose and duration of treatment are determined by the type and location of the infection, the susceptibility of the bacteria, and the patient’s weight and age. Gentamicin is also available as an eye drop or an ear drop, which is used to treat local infections of the eye or the ear.
Gentamicin can cause serious side effects, such as impairment of kidney function and hearing loss. These side effects are more likely to occur in patients who have pre-existing kidney problems, are elderly, are dehydrated, or are receiving high doses or prolonged treatment. Therefore, gentamicin should be used with caution and under the guidance of a healthcare provider. The levels of gentamicin in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. Other possible side effects of gentamicin include allergic reactions, nausea, vomiting, headache, dizziness, and muscle weakness.
Tobramycin is another 4,6-disubstituted 2-DOS aminoglycoside, which is similar to gentamicin in its structure and mechanism of action. It is composed of two components: tobramycin A and B. Tobramycin binds to the 30S subunit of the bacterial ribosome, and inhibits protein synthesis in the same way as gentamicin.
Tobramycin has a narrower spectrum of activity than gentamicin and is mainly used to treat infections caused by Pseudomonas aeruginosa, a common cause of hospital-acquired infections, especially in patients with cystic fibrosis, burns, or immunosuppression. Tobramycin is also active against some other gram-negative bacteria, such as Escherichia coli, Klebsiella, Proteus, and Serratia, but less so than gentamicin. Tobramycin is not effective against gram-positive bacteria, anaerobic bacteria, fungi, or viruses. Tobramycin is often used in combination with other antibiotics, such as penicillins, cephalosporins, or carbapenems, to treat serious infections, such as septicemia, pneumonia, meningitis, and osteomyelitis.
Tobramycin is not well absorbed when given by mouth, so it needs to be given by injection by healthcare personnel. It is usually administered once or twice a day, depending on the severity of the infection and the patient’s kidney function. The dose and duration of treatment are determined by the type and location of the infection, the susceptibility of the bacteria, and the patient’s weight and age. Tobramycin is also available as an eye drop or an ear drop, which are used to treat local infections of the eye or the ear. In addition, it can be administered by inhalation to treat respiratory infections in cystic fibrosis patients.
Tobramycin can cause serious side effects, such as impairment of kidney function and hearing loss, similar to gentamicin.
These side effects are more likely to occur in patients who have pre-existing kidney problems, are elderly, are dehydrated, or are receiving high doses or prolonged treatment. Therefore, tobramycin should be used with caution and under the guidance of a healthcare provider. The levels of tobramycin in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. Other possible side effects of tobramycin include allergic reactions, nausea, vomiting, headache, dizziness, and muscle weakness.
Amikacin
Amikacin is a 4,5-disubstituted 2-DOS aminoglycoside, which means that it has two sugar rings attached to the 4 and 5 positions of the 2-DOS ring. It is a semi-synthetic derivative of kanamycin, another aminoglycoside. Amikacin binds to the 30S subunit of the bacterial ribosome and inhibits protein synthesis in the same way as gentamicin and tobramycin.
Amikacin has a broader spectrum of activity than gentamicin and tobramycin and is more resistant to bacterial enzymes that inactivate aminoglycosides. It is effective against many gram-negative bacteria, such as Acinetobacter, Citrobacter, Enterobacter, and Providencia, as well as some gram-positive bacteria, such as Staphylococcus and Streptococcus. Amikacin is also used to treat infections caused by Mycobacterium tuberculosis, the bacterium that causes tuberculosis. Amikacin is often used in combination with other antibiotics, such as isoniazid, rifampin, or ethambutol, to treat tuberculosis, especially when the bacteria are resistant to other drugs.
Amikacin is not well absorbed when given by mouth, so it needs to be given by injection by healthcare personnel. It is usually administered once or twice a day, depending on the severity of the infection and the patient’s kidney function. The dose and duration of treatment are determined by the type and location of the infection, the susceptibility of the bacteria, and the patient’s weight and age.
Amikacin can cause serious side effects, such as impairment of kidney function and hearing loss, similar to gentamicin and tobramycin. These side effects are more likely to occur in patients who have pre-existing kidney problems, are elderly, are dehydrated, or are receiving high doses or prolonged treatment. Therefore, amikacin should be used with caution and under the guidance of a healthcare provider. The levels of amikacin in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. Other possible side effects of amikacin include allergic reactions, nausea, vomiting, headache, dizziness, and muscle weakness.
Streptomycin
Streptomycin is a non-2-DOS aminoglycoside, which means that it does not contain a 2-DOS ring in its structure. It has a streptidine ring, which is a six-membered ring with one amino group and one nitrogen atom, attached to two other sugar rings. Streptomycin binds to the 30S subunit of the bacterial ribosome but in a different way than the 2-DOS aminoglycosides. It causes misreading of the genetic code, leading to the production of defective proteins, but it does not block the initiation or elongation of protein synthesis, or induce the formation of abnormal polysomes.
Streptomycin has a narrow spectrum of activity and is mainly used to treat infections caused by Mycobacterium tuberculosis and Mycobacterium leprae, the bacteria that cause tuberculosis and leprosy, respectively. Streptomycin is also used to treat plague, tularemia, and brucellosis, which are rare but serious infections caused by Yersinia pestis, Francisella tularensis, and Brucella spp., respectively. Streptomycin is often used in combination with other antibiotics, such as isoniazid, rifampin, or doxycycline, to treat these infections, especially when the bacteria are resistant to other drugs.
Streptomycin's oral route is ineffective in absorption, thus necessitating injection by healthcare personnel. It is usually administered once or twice a day, depending on the severity of the infection and the patient’s kidney function. The dose and duration of treatment are determined by the type and location of the infection, the susceptibility of the bacteria, and the patient’s weight and age.
Streptomycin can cause serious side effects, such as impairment of kidney function and hearing loss, similar to gentamicin, tobramycin, and amikacin. These side effects are more likely to occur in patients who have pre-existing kidney problems, are elderly, are dehydrated, or are receiving high doses or prolonged treatment. Therefore, streptomycin should be used with caution and under the guidance of a healthcare provider. The levels of streptomycin in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. Other possible side effects of streptomycin include allergic reactions, nausea, vomiting, headache, dizziness, and muscle weakness.
Aminoglycosides Classification
Classification Based on Chemical Structure
Aminoglycosides can be classified into different classes based on their chemical structures, which affect their spectra of activity, pharmacokinetics, and adverse effects. The main classes are:
Class I: These are the oldest and most diverse group of aminoglycosides, and include streptomycin, kanamycin, neomycin, and paromomycin. They have a streptidine or a 2-DOS ring attached to two other sugar rings. They have a narrow spectrum of activity and are mainly effective against Mycobacterium spp. and some gram-positive bacteria. They are also the most toxic group of aminoglycosides and can cause severe kidney damage and hearing loss.
Class II: These are the most commonly used group of aminoglycosides, and include gentamicin, tobramycin, amikacin, and netilmicin. They have a 2-DOS ring attached to one or two other sugar rings. They have a broad spectrum of activity and are effective against many gram-negative bacteria and some gram-positive bacteria. They are less toxic than class I aminoglycosides, but still can cause kidney damage and hearing loss.
Class III: These are the newest and most advanced group of aminoglycosides, and include plazomicin, sisomicin, and apramycin. They have a hydroxylated 6’-N-aminoglycoside ring or a 2-DOS ring attached to one or two other sugar rings. They have an extended spectrum of activity and are effective against many gram-negative bacteria, including those that are resistant to class II aminoglycosides. They are also less toxic than class I and II aminoglycosides, and have a lower risk of causing kidney damage and hearing loss.
Differentiating Between Classes
The following table summarizes the main differences between the three classes of aminoglycosides:
Table
Class
Ring Structure
Spectrum of Activity
Toxicity
I
Streptidine or 2-DOS + 2 sugar rings
Narrow, mainly Mycobacterium spp. and some gram-positive bacteria
High, severe kidney damage and hearing loss
II
2-DOS + 1 or 2 sugar rings
Broad, many gram-negative bacteria and some gram-positive bacteria
Moderate, kidney damage and hearing loss
III
Hydroxylated 6’-N-aminoglycoside or 2-DOS + 1 or 2 sugar rings
Extended, many gram-negative bacteria, including resistant ones
Low, lower risk of kidney damage and hearing loss
Aminoglycosides Uses
Treatment of Bacterial Infections
Aminoglycosides are used to treat serious bacterial infections that are difficult to treat with other antibiotics. They are especially effective against aerobic, gram-negative bacteria, which are often resistant to other classes of antibiotics, such as penicillins, cephalosporins, or macrolides. Aminoglycosides are also used to treat some gram-positive bacteria, such as Staphylococci and Mycobacterium spp., which can cause infections such as endocarditis, osteomyelitis, tuberculosis, and leprosy.
Aminoglycosides are not well absorbed when given by mouth, so they need to be given by injection by healthcare personnel. They are usually administered once or twice a day, depending on the severity of the infection and the patient’s kidney function. The dose and duration of treatment are determined by the type and location of the infection, the susceptibility of the bacteria, and the patient’s weight and age. Aminoglycosides are also available as topical agents for eye, ear, and skin infections.
Spectrum of Activity
Aminoglycosides have a variable spectrum of activity, depending on their chemical structure and their mode of action. The main groups of bacteria that are susceptible to aminoglycosides are:
Aerobic, gram-negative bacteria: These are the most common targets of aminoglycosides, and include bacteria such as Escherichia coli, Klebsiella, Proteus, Pseudomonas, Serratia, Acinetobacter, Citrobacter, Enterobacter, and Providencia. These bacteria can cause infections such as septicemia, pneumonia, meningitis, urinary tract infections, and wound infections. Aminoglycosides are often the drugs of choice for these infections, especially when the bacteria are resistant to other antibiotics.
Some gram-positive bacteria: Aminoglycosides are also active against some gram-positive bacteria, such as Staphylococcus aureus and Enterococcus. These bacteria can cause infections such as endocarditis, osteomyelitis, and skin infections. However, aminoglycosides are usually less effective than other antibiotics, such as penicillins, cephalosporins, or vancomycin, for these infections. Aminoglycosides are often used in combination with these antibiotics to enhance their effectiveness and prevent resistance.
Mycobacterium spp.: Aminoglycosides are also used to treat infections caused by Mycobacterium tuberculosis and Mycobacterium leprae, the bacteria that cause tuberculosis and leprosy, respectively. These bacteria are difficult to treat with other antibiotics and often require prolonged and multidrug therapy. Aminoglycosides are often used in combination with other antibiotics, such as isoniazid, rifampin, or ethambutol, to treat these infections, especially when the bacteria are resistant to other drugs.
Aminoglycosides are not effective against anaerobic bacteria, fungi, or viruses. Therefore, they are not used to treat infections caused by these organisms.
Combination Therapy with Other Antibiotics
Aminoglycosides are often used in combination with other antibiotics to treat serious infections, for several reasons:
Synergy: Some combinations of antibiotics can have a synergistic effect, which means that they work better together than alone. For example, aminoglycosides can enhance the activity of penicillins, cephalosporins, or vancomycin against gram-positive bacteria, by facilitating their entry into the bacterial cell wall. Similarly, aminoglycosides can enhance the activity of isoniazid, rifampin, or ethambutol against Mycobacterium spp., by increasing their uptake into the bacterial cell.
Broadening the spectrum: Some combinations of antibiotics can broaden the spectrum of activity, which means that they can cover more types of bacteria. For example, aminoglycosides can broaden the spectrum of penicillins, cephalosporins, or carbapenems against gram-negative bacteria, by adding activity against Pseudomonas aeruginosa and other resistant bacteria. Similarly, aminoglycosides can broaden the spectrum of isoniazid, rifampin, or ethambutol against Mycobacterium spp., by adding activity against atypical mycobacteria.
Preventing resistance: Some combinations of antibiotics can prevent resistance, which means that they can reduce the chance of bacteria becoming resistant to the antibiotics. For example, aminoglycosides can prevent resistance to penicillins, cephalosporins, or vancomycin against gram-positive bacteria, by killing the bacteria that produce enzymes that inactivate these antibiotics. Similarly, aminoglycosides can prevent resistance to isoniazid, rifampin, or ethambutol against Mycobacterium spp., by killing the bacteria that mutate their targets or transporters of these antibiotics.
However, combination therapy with aminoglycosides also has some drawbacks, such as:
Increased toxicity: Some combinations of antibiotics can increase the toxicity, which means that they can cause more side effects. For example, aminoglycosides can increase the toxicity of penicillins, cephalosporins, or vancomycin against gram-positive bacteria, by increasing the risk of kidney damage and hearing loss. Similarly, aminoglycosides can increase the toxicity of isoniazid, rifampin, or ethambutol against Mycobacterium spp., by increasing the risk of liver damage and nerve damage.
Increased cost: Some combinations of antibiotics can increase the cost, which means that they can be more expensive. For example, aminoglycosides can increase the cost of penicillins, cephalosporins, or vancomycin against gram-positive bacteria, by requiring more frequent monitoring of blood and urine levels. Similarly, aminoglycosides can increase the cost of isoniazid, rifampin, or ethambutol against Mycobacterium spp., by requiring more frequent testing of liver and nerve function.
Therefore, combination therapy with aminoglycosides should be used with caution and under the guidance of a healthcare provider. The benefits and risks of each combination should be weighed carefully, and the optimal dose and duration of treatment should be determined based on the type and location of the infection, the susceptibility of the bacteria, and the patient’s condition and response.
Aminoglycosides Side Effects
Aminoglycosides can cause serious side effects, which can limit their use and require careful monitoring. The most common and severe side effects of aminoglycosides are:
Nephrotoxicity
Nephrotoxicity is the damage to the kidneys caused by aminoglycosides. Aminoglycosides can accumulate in the kidney cells and interfere with their function, leading to reduced urine output, increased blood urea nitrogen and creatinine levels, and electrolyte imbalances. Nephrotoxicity can be reversible if the drug is stopped early, but it can also be irreversible if the damage is severe. Nephrotoxicity can lead to acute kidney injury, chronic kidney disease, or end-stage renal disease, which may require dialysis or transplantation.
Nephrotoxicity is more likely to occur in patients who have pre-existing kidney problems, are elderly, are dehydrated, or are receiving high doses or prolonged treatment. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider. The levels of aminoglycosides in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. The dose and duration of treatment should be adjusted based on the patient’s kidney function and response. Other drugs that can damage the kidneys, such as nonsteroidal anti-inflammatory drugs, contrast agents, or other nephrotoxic antibiotics, should be avoided or used with caution. The patient should also be well hydrated and maintain a normal blood pressure.
Ototoxicity
Ototoxicity is the damage to the ears caused by aminoglycosides. Aminoglycosides can accumulate in the inner ear cells and interfere with their function, leading to hearing loss, tinnitus, vertigo, or balance problems. Ototoxicity can be reversible if the drug is stopped early, but it can also be irreversible if the damage is severe. Ototoxicity can lead to permanent hearing impairment, deafness, or vestibular dysfunction, which may affect the quality of life and the ability to communicate.
Ototoxicity is more likely to occur in patients who have pre-existing hearing problems, are elderly, are dehydrated, or are receiving high doses or prolonged treatment. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider. The levels of aminoglycosides in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. The dose and duration of treatment should be adjusted based on the patient’s hearing function and response. Other drugs that can damage the ears, such as loop diuretics, salicylates, or other ototoxic antibiotics, should be avoided or used with caution.
The patient should also be monitored for signs and symptoms of hearing loss, such as difficulty hearing, ringing in the ears, or dizziness. The patient should also avoid exposure to loud noises and protect their ears from injury.
Allergic Reactions
Allergic reactions are the hypersensitivity reactions caused by aminoglycosides. Aminoglycosides can trigger the immune system to produce antibodies that recognize the drug as a foreign substance and attack it. This can result in inflammation, swelling, itching, rash, hives, or anaphylaxis. Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause difficulty breathing, low blood pressure, shock, or death.
Allergic reactions are more likely to occur in patients who have a history of allergy to aminoglycosides or other drugs, or who are receiving repeated or prolonged treatment. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider. The patient should be tested for allergy to aminoglycosides before starting the treatment and should be observed for any signs and symptoms of allergic reactions during the treatment. The patient should also inform the healthcare provider of any other allergies or medications they are taking. If an allergic reaction occurs, the drug should be stopped immediately and the patient should receive appropriate treatment, such as antihistamines, corticosteroids, or epinephrine.
Is Vancomycin an Aminoglycoside?
Clarifying the Distinction
Vancomycin is not an aminoglycoside, although it is sometimes confused with one. Vancomycin is a glycopeptide antibiotic, which means that it is composed of amino acids and sugars, but not in the same way as aminoglycosides. Vancomycin has a heptapeptide core, which is a chain of seven amino acids, attached to two sugar rings. Vancomycin does not have a 2-DOS ring, a streptidine ring, or a hydroxylated 6’-N-aminoglycoside ring, which are characteristic of aminoglycosides.
Vancomycin is also different from aminoglycosides in its mechanism of action, spectrum of activity, pharmacokinetics, and adverse effects. Therefore, vancomycin should not be considered as an aminoglycoside, and should not be used interchangeably with one.
Differences in Mechanism of Action
Vancomycin works by binding to the bacterial cell wall, which is the outer layer that protects and supports the bacterial cell. Vancomycin specifically binds to the D-alanyl-D-alanine terminus of the peptidoglycan, which is the main component of the cell wall. By doing so, vancomycin prevents the cross-linking of the peptidoglycan chains, which are essential for the strength and integrity of the cell wall. As a result, the bacterial cell wall becomes weak and unstable, and the bacterial cell dies or becomes more susceptible to other antibiotics or the host defense mechanisms.
Aminoglycosides work by binding to the bacterial ribosomes, which are the structures that make proteins from the genetic information in the bacterial DNA. Aminoglycosides interfere with the accuracy and efficiency of the protein synthesis process, leading to the production of faulty or incomplete proteins. These defective proteins can have various effects on the bacterial cell, such as disrupting the cell membrane, impairing the enzyme activity, or triggering the immune system. As a result, the bacterial cell dies or becomes more susceptible to other antibiotics or the host defense mechanisms.
Therefore, vancomycin and aminoglycosides have different targets and modes of action, and they affect different aspects of the bacterial cell. Vancomycin affects the cell wall, while aminoglycosides affect the ribosomes. Vancomycin prevents the formation of the cell wall, while aminoglycosides inhibit the production of proteins. Vancomycin and aminoglycosides can have synergistic or additive effects when used together, as they can attack the bacteria from different angles and increase the bacterial killing. However, they can also have antagonistic or inhibitory effects when used together, as they can interfere with each other’s binding or uptake into the bacterial cell. Therefore, the combination of vancomycin and aminoglycosides should be used with caution and under the guidance of a healthcare provider. The optimal dose and duration of treatment should be determined based on the type and location of the infection, the susceptibility of the bacteria, and the patient’s condition and response.
Aminoglycosides Contraindications
Precautions in Special Populations
Aminoglycosides should be used with caution and under the guidance of a healthcare provider in some special populations, such as:
Pregnant women: Aminoglycosides can cross the placenta and reach the fetus, where they can cause damage to the fetal kidneys and ears. Aminoglycosides can also increase the risk of premature birth, low birth weight, or congenital malformations. Therefore, aminoglycosides should be avoided during pregnancy, unless the benefits outweigh the risks. The pregnant woman and the fetus should be monitored closely for any signs and symptoms of toxicity.
Breastfeeding women: Aminoglycosides can pass into the breast milk and reach the nursing infant, where they can cause damage to the infant’s kidneys and ears. Aminoglycosides can also affect the growth and development of the infant. Therefore, aminoglycosides should be avoided during breastfeeding, unless the benefits outweigh the risks. The breastfeeding woman and the infant should be monitored closely for any signs and symptoms of toxicity.
Children: Aminoglycosides can affect the growth and development of children, especially their bones and teeth. Aminoglycosides can also cause damage to the children’s kidneys and ears, which can be more severe and irreversible than in adults. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider in children. The dose and duration of treatment should be adjusted based on the child’s weight and age. The child should be monitored closely for any signs and symptoms of toxicity.
Elderly: Aminoglycosides can cause more side effects and toxicity in elderly patients, who are more likely to have reduced kidney function, hearing impairment, or other medical conditions. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider in elderly patients. The dose and duration of treatment should be adjusted based on the patient’s kidney function and response. The patient should be monitored closely for any signs and symptoms of toxicity.
Drug Interactions and Cautions
Aminoglycosides can interact with other drugs and cause adverse effects, such as:
Nephrotoxic drugs: These are drugs that can damage the kidneys, such as nonsteroidal anti-inflammatory drugs, contrast agents, or other nephrotoxic antibiotics, such as cephalosporins, vancomycin, or amphotericin B. These drugs can increase the risk of kidney damage and failure when used with aminoglycosides. Therefore, these drugs should be avoided or used with caution when taking aminoglycosides. The levels of aminoglycosides and the other drugs in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. The patient should also be well hydrated and maintain a normal blood pressure.
Ototoxic drugs: These are drugs that can damage the ears, such as loop diuretics, salicylates, or other ototoxic antibiotics, such as erythromycin, clindamycin, or polymyxins. These drugs can increase the risk of hearing loss and balance problems when used with aminoglycosides. Therefore, these drugs should be avoided or used with caution when taking aminoglycosides. The levels of aminoglycosides and the other drugs in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. The patient should also be monitored for any signs and symptoms of hearing loss, such as difficulty hearing, ringing in the ears, or dizziness.
Neuromuscular blocking agents: These are drugs that can block the transmission of nerve impulses to the muscles, such as succinylcholine, pancuronium, or vecuronium. These drugs can increase the risk of muscle weakness and paralysis when used with aminoglycosides. Therefore, these drugs should be avoided or used with caution when taking aminoglycosides. The levels of aminoglycosides and the other drugs in the blood and urine should be monitored regularly to ensure that they are within the safe and effective range. The patient should also be monitored for any signs and symptoms of muscle weakness, such as difficulty breathing, swallowing, or moving.
Other antibiotics: These are drugs that can affect the bacterial growth and resistance, such as penicillins, cephalosporins, carbapenems, vancomycin, or isoniazid. These drugs can have synergistic, additive, or antagonistic effects when used with aminoglycosides. Therefore, these drugs should be used with caution and under the guidance of a healthcare provider when taking aminoglycosides. The optimal dose and duration of treatment should be determined based on the type and location of the infection, the susceptibility of the bacteria, and the patient’s condition and response.
Diagnosis and Assessment
Clinical Evaluation
The diagnosis and assessment of a bacterial infection that requires aminoglycosides treatment should be based on a clinical evaluation, which includes:
History: The patient should be asked about their symptoms, such as fever, pain, swelling, redness, pus, or discharge. The patient should also be asked about their medical history, such as previous infections, allergies, medications, or other medical conditions. The patient should also be asked about their exposure to possible sources of infection, such as animals, food, water, or other people.
Physical examination: The patient should be examined for any signs of infection, such as inflammation, tenderness, warmth, or drainage. The patient should also be examined for any signs of toxicity, such as kidney damage or hearing loss. The patient should also have their vital signs measured, such as temperature, pulse, blood pressure, and respiratory rate.
Imaging tests: The patient may need to have some imaging tests, such as X-rays, ultrasound, computed tomography, or magnetic resonance imaging, to visualize the location and extent of the infection, and to rule out any complications, such as abscesses, bone fractures, or organ damage.
Laboratory Testing (Culture and Sensitivity)
The diagnosis and assessment of a bacterial infection that requires aminoglycosides treatment should also be based on laboratory testing, which includes:
Culture: The patient may need to have some samples taken from the site of infection, such as blood, urine, sputum, wound, or cerebrospinal fluid, and sent to the laboratory for culture. Culture is the process of growing the bacteria in a special medium, and identifying them based on their appearance, growth pattern, and biochemical reactions. Culture can confirm the presence and type of bacteria causing the infection, and help guide the choice of antibiotics.
Sensitivity: The patient may also need to have some samples taken from the site of infection, and sent to the laboratory for sensitivity. Sensitivity is the process of testing the bacteria against different antibiotics, and measuring their ability to resist or inhibit them. Sensitivity can determine the susceptibility and resistance of the bacteria to different antibiotics, and help guide the dose and duration of treatment.
Consideration of Patient-Specific Factors
The diagnosis and assessment of a bacterial infection that requires aminoglycosides treatment should also consider some patient-specific factors, such as:
Age: The patient’s age can affect the pharmacokinetics and pharmacodynamics of aminoglycosides, as well as the risk of toxicity and side effects. Children and elderly patients may need lower doses and shorter durations of treatment, and more frequent monitoring of blood and urine levels, than adults.
Weight: The patient’s weight can affect the pharmacokinetics and pharmacodynamics of aminoglycosides, as well as the risk of toxicity and side effects. Obese and underweight patients may need different doses and durations of treatment, and more frequent monitoring of blood and urine levels, than normal-weight patients.
Kidney function: The patient’s kidney function can affect the pharmacokinetics and pharmacodynamics of aminoglycosides, as well as the risk of toxicity and side effects. Patients with impaired kidney function may need lower doses and shorter durations of treatment, and more frequent monitoring of blood and urine levels, than patients with normal kidney function.
Hearing function: The patient’s hearing function can affect the risk of toxicity and side effects of aminoglycosides. Patients with impaired hearing function may need lower doses and shorter durations of treatment, and more frequent monitoring of blood and urine levels, than patients with normal hearing function.
Allergy: The patient’s allergy can affect the choice and safety of aminoglycosides. Patients with a history of allergy to aminoglycosides or other drugs should be tested for allergy before starting the treatment and should be observed for any signs and symptoms of allergic reactions during the treatment.
The treatment approaches for a bacterial infection that requires aminoglycosides treatment should include the administration routes, which are:
Intramuscular: This is an alternative route of administration for aminoglycosides, which can be used when intravenous access is not available or feasible. Intramuscular administration requires the injection of the drug solution into a muscle, usually the buttock, thigh, or arm. Intramuscular administration can also be done as a single daily dose, or as multiple divided doses, depending on the severity of the infection and the patient’s kidney function. Intramuscular administration can be more painful and inconvenient than intravenous administration and can cause local irritation or infection at the injection site.
Topical: This is a local route of administration for aminoglycosides, which can be used to treat eye, ear, or skin infections. Topical administration requires the application of the drug solution or ointment to the affected area, usually as drops, sprays, or creams. Topical administration can be done as needed, or as prescribed by the healthcare provider. Topical administration can be less effective and more prone to resistance than systemic administration and can cause local irritation or allergy at the application site.
Dosage Guidelines
The treatment approaches for a bacterial infection that requires aminoglycosides treatment should also include the dosage guidelines, which are:
Dose: The dose of aminoglycosides depends on the type and severity of the infection, the susceptibility of the bacteria, the patient’s weight and age, and the patient’s kidney function. The dose is usually expressed as milligrams per kilogram of body weight per day (mg/kg/day), and can range from 3 to 15 mg/kg/day, depending on the drug and the infection. The dose can be given as a single daily dose, or as multiple divided doses, depending on the pharmacokinetics and pharmacodynamics of the drug and the patient. The dose should be adjusted based on the patient’s response and the levels of the drug in the blood and urine.
Duration: The duration of aminoglycosides treatment depends on the type and location of the infection, the susceptibility of the bacteria, and the patient’s condition and response. The duration can range from 3 to 14 days, depending on the drug and the infection. The duration should be as short as possible to minimize the risk of toxicity and resistance, but as long as necessary to ensure the complete eradication of the infection. The duration should be adjusted based on the patient’s response and the results of the culture and sensitivity tests.
Duration of Treatment
The treatment approaches for a bacterial infection that requires aminoglycosides treatment should also include the duration of treatment, which is:
Follow-up: The patient should have a follow-up visit with the healthcare provider after completing the aminoglycosides treatment, to evaluate the outcome of the treatment, and to monitor for any signs and symptoms of toxicity, side effects, or complications. The patient should also have a repeat culture and sensitivity test, to confirm the clearance of the infection, and to detect any possible resistance or relapse. The patient should also have a hearing test, to assess the function of the ears, and a kidney function test, to assess the function of the kidneys. The patient should also report any new or worsening symptoms, such as fever, pain, swelling, redness, pus, discharge, difficulty hearing, ringing in the ears, dizziness, difficulty breathing, swallowing, or moving, nausea, vomiting, headache, or rash. The patient should also inform the healthcare provider of any other medications or supplements they are taking or any changes in their medical history or condition.
Patient Education and Follow-up
Understanding the Importance of Adherence
Patients who are prescribed aminoglycosides should understand the importance of adherence, which means following the instructions of the healthcare provider and taking the medication as prescribed. Adherence is essential for the success of the treatment, as it ensures the optimal level of the drug in the body and the site of infection, and the complete eradication of the bacteria. Adherence also reduces the risk of toxicity, side effects, and complications, as it prevents overdosing or underdosing of the drug. Adherence also prevents resistance, as it avoids the exposure of the bacteria to suboptimal concentrations of the drug, which can be selected for resistant mutants.
Patients should be educated about the following aspects of adherence:
Dose: Patients should take the exact dose of aminoglycosides that is prescribed by the healthcare provider, and not change it without consulting the healthcare provider. Patients should not take more or less than the prescribed dose, as this can affect the effectiveness and safety of the treatment. Patients should also not skip or miss any doses, as this can reduce the level of the drug in the body and the site of infection, and allow the bacteria to grow back. Patients should also not stop taking the drug before completing the course of treatment, as this can leave some bacteria alive, and cause the infection to recur or worsen.
Duration: Patients should take the aminoglycosides for the entire duration of treatment that is prescribed by the healthcare provider, and not stop it prematurely or extend it unnecessarily. Patients should not stop taking the drug even if they feel better or their symptoms improve, as this can indicate that the infection is not fully cleared, and that some bacteria may still be present. Patients should also not continue taking the drug longer than the prescribed duration, as this can increase the risk of toxicity, side effects, and resistance.
Timing: Patients should take the aminoglycosides at the same time every day, or as instructed by the healthcare provider, and not vary the timing of the doses. Patients should not take the drug too close or too far apart, as this can affect the level of the drug in the body and the site of infection, and the bacterial killing. Patients should also not take the drug with food or drinks, unless advised by the healthcare provider, as this can affect the absorption and distribution of the drug.
Recognizing and Reporting Side Effects
Patients who are taking aminoglycosides should recognize and report any side effects that they may experience, as some of them can be serious and potentially life-threatening. Side effects are the unwanted or harmful effects of the drug, which can occur in addition to or instead of the desired effects. Side effects can vary in severity, frequency, and duration, depending on the type and dose of the drug, the patient’s condition and response, and the patient’s individual sensitivity.
Patients should be educated about the following side effects of aminoglycosides:
Nephrotoxicity: This is the damage to the kidneys caused by aminoglycosides, which can result in reduced urine output, increased blood urea nitrogen and creatinine levels, and electrolyte imbalances. Nephrotoxicity can be reversible if the drug is stopped early, but it can also be irreversible if the damage is severe. Nephrotoxicity can lead to acute kidney injury, chronic kidney disease, or end-stage renal disease, which may require dialysis or transplantation. Patients should monitor their urine output and color, and report any changes or abnormalities to the healthcare provider. Patients should also have their blood and urine tested regularly to check their kidney function and the levels of the drug. Patients should also drink plenty of fluids and maintain a normal blood pressure.
Ototoxicity: This is the damage to the ears caused by aminoglycosides, which can result in hearing loss, tinnitus, vertigo, or balance problems. Ototoxicity can be reversible if the drug is stopped early, but it can also be irreversible if the damage is severe. Ototoxicity can lead to permanent hearing impairment, deafness, or vestibular dysfunction, which may affect the quality of life and the ability to communicate. Patients should monitor their hearing and balance, and report any changes or difficulties to the healthcare provider. Patients should also have their hearing tested regularly to check their ear function and the levels of the drug. Patients should also avoid exposure to loud noises and protect their ears from injury.
Allergic reactions: These are the hypersensitivity reactions caused by aminoglycosides, which can result in inflammation, swelling, itching, rash, hives, or anaphylaxis. Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause difficulty breathing, low blood pressure, shock, or death. Patients should report any signs or symptoms of allergic reactions to the healthcare provider immediately, and seek emergency medical attention if they experience anaphylaxis. Patients should also inform the healthcare provider of any other allergies or medications they are taking. Patients should also carry an epinephrine auto-injector, if prescribed, and use it as instructed in case of anaphylaxis.
Follow-up Appointments and Monitoring
Patients who are taking aminoglycosides should have follow-up appointments and monitoring with the healthcare provider, to evaluate the outcome of the treatment, and to monitor for any signs and symptoms of toxicity, side effects, or complications. Follow-up appointments and monitoring are essential for the success and safety of the treatment, as they can ensure the optimal level of the drug in the body and the site of infection, the complete eradication of the bacteria, and the prevention of resistance. Follow-up appointments and monitoring can also detect and treat any problems that may arise during or after the treatment, and prevent any long-term or permanent damage.
Patients should be educated about the following aspects of follow-up appointments and monitoring:
Follow-up visit: Patients should have a follow-up visit with the healthcare provider after completing the aminoglycosides treatment, usually within a week or two, or as advised by the healthcare provider. The follow-up visit can include a physical examination, a review of the symptoms and the medication, and a discussion of the outcome and the next steps. The follow-up visit can also include a repeat culture and sensitivity test, to confirm the clearance of the infection, and to detect any possible resistance or relapse. The follow-up visit can also include a hearing test, to assess the function of the ears, and a kidney function test, to assess the function of the kidneys.
Monitoring: Patients should also monitor themselves for any signs and symptoms of toxicity, side effects, or complications, during and after the aminoglycosides treatment, and report them to the healthcare provider as soon as possible. Patients should also monitor their urine output and color, their hearing and balance, and their vital signs, such as temperature, pulse, blood pressure, and respiratory rate. Patients should also have their blood and urine tested regularly, to check their kidney function and the levels of the drug. Patients should also report any new or worsening symptoms, such as fever, pain, swelling, redness, pus, discharge, difficulty hearing, ringing in the ears, dizziness, difficulty breathing, swallowing, or moving, nausea, vomiting, headache, or rash.
Future Developments and Alternatives
Research on New Aminoglycosides
Aminoglycosides are a valuable and powerful tool in the fight against bacterial infections, but they also face some limitations, such as bacterial resistance, poor penetration into some tissues, and incompatibility with some other drugs. Therefore, there is a need for research on new aminoglycosides, which can overcome these limitations and improve the effectiveness and safety of the treatment.
Some of the research on new aminoglycosides are:
Synthetic aminoglycosides: These are aminoglycosides that are synthesized in the laboratory, rather than derived from natural sources, such as bacteria or fungi. Synthetic aminoglycosides can have modified structures and properties, which can enhance their activity and stability, and reduce their toxicity and resistance. For example, plazomicin is a synthetic aminoglycoside that has a hydroxylated 6’-N-aminoglycoside ring, which increases its binding to the bacterial ribosome, and its resistance to bacterial enzymes that inactivate aminoglycosides. Plazomicin is effective against many gram-negative bacteria, including those that are resistant to other aminoglycosides, and has a lower risk of causing kidney damage and hearing loss. Plazomicin was approved by the US Food and Drug Administration (FDA) in 2018, for the treatment of complicated urinary tract infections.
Semi-synthetic aminoglycosides: These are aminoglycosides that are derived from natural sources, but are modified in the laboratory, to improve their characteristics and performance. Semi-synthetic aminoglycosides can have altered structures and properties, which can enhance their spectrum and potency, and reduce their toxicity and resistance. For example, amikacin is a semi-synthetic derivative of kanamycin, another aminoglycoside. Amikacin has a broader spectrum of activity than kanamycin and is more resistant to bacterial enzymes that inactivate aminoglycosides. Amikacin is effective against many gram-negative bacteria, as well as some gram-positive bacteria, such as Staphylococcus and Streptococcus. Amikacin is also used to treat infections caused by Mycobacterium spp., the bacteria that cause tuberculosis. Amikacin is only available as an injection.
Emerging Trends in Antibiotic Therapy
Aminoglycosides are part of the emerging trends in antibiotic therapy, which aim to address the challenges and opportunities in the field of infectious diseases. Some of the emerging trends in antibiotic therapy are:
Antibiotic stewardship: This is the practice of using antibiotics wisely and responsibly, to preserve their effectiveness and prevent resistance. Antibiotic stewardship involves choosing the right antibiotic, at the right dose, for the right duration, and for the right patient. Antibiotic stewardship also involves educating the healthcare providers and the public about the proper use and misuse of antibiotics and monitoring the patterns and outcomes of antibiotic use and resistance. Antibiotic stewardship can improve the quality and safety of patient care, and reduce the costs and complications of antibiotic therapy.
Novel targets and mechanisms: This is the discovery and development of new antibiotics that have novel targets and mechanisms of action, which can overcome the existing resistance mechanisms and expand the therapeutic options. Novel targets and mechanisms can include interfering with bacterial cell division, metabolism, communication, or virulence, rather than the traditional targets of cell wall, ribosome, or DNA. Novel targets and mechanisms can also include enhancing the host defense mechanisms, such as the immune system, the microbiome, or the phage therapy, rather than relying solely on the antibiotics. Novel targets and mechanisms can offer new hope and opportunities for the treatment of difficult-to-treat infections.
Personalized medicine: This is the tailoring of antibiotic therapy to the individual characteristics and needs of each patient, rather than the one-size-fits-all approach. Personalized medicine can involve using biomarkers, genomics, proteomics, or metabolomics, to identify the patient’s susceptibility and response to different antibiotics, and to optimize the dose and duration of treatment. Personalized medicine can also involve using rapid and accurate diagnostic tests, such as molecular or biosensor techniques, to identify the type and resistance of the bacteria causing the infection, and to guide the choice of antibiotics. Personalized medicine can improve the effectiveness and safety of antibiotic therapy, and reduce the unnecessary use and waste of antibiotics.
Conclusion
Recap of Key Points
Aminoglycosides are a class of antibiotics that are used to treat serious infections caused by bacteria that are difficult to treat with other antibiotics. Aminoglycosides work by binding to the bacterial ribosomes and inhibiting protein synthesis, leading to the death or weakening of the bacteria. Aminoglycosides have a variable spectrum of activity, depending on their chemical structure and their mode of action. Aminoglycosides are often used in combination with other antibiotics to enhance their effectiveness and prevent resistance. Aminoglycosides have a narrow margin between a safe and a toxic dose, and they can cause serious side effects, such as impairment of kidney function and hearing loss. Therefore, aminoglycosides should be used with caution and under the guidance of a healthcare provider. The diagnosis and assessment of a bacterial infection that requires aminoglycoside treatment should be based on a clinical evaluation, laboratory testing, and a consideration of patient-specific factors. The treatment approaches for a bacterial infection that requires aminoglycoside treatment should include the administration routes, the dosage guidelines, and the duration of treatment. The patient should have a follow-up visit with the healthcare provider after completing the aminoglycosides treatment, to evaluate the outcome of the treatment, and to monitor for any signs and symptoms of toxicity, side effects, or complications. Aminoglycosides are a valuable and powerful tool in the fight against bacterial infections, but they also face some limitations, such as bacterial resistance, poor penetration into some tissues, and incompatibility with some other drugs. Therefore, there is a need for research on new aminoglycosides, which can overcome these limitations and improve the effectiveness and safety of the treatment. Aminoglycosides are also part of the emerging trends in antibiotic therapy, which aim to address the challenges and opportunities in the field of infectious diseases.
Balancing the Benefits and Risks of Aminoglycoside Use
Aminoglycosides are a double-edged sword, as they have both benefits and risks for the treatment of bacterial infections. The benefits of aminoglycosides are that they can kill or weaken the bacteria that are difficult to treat with other antibiotics and that they can enhance the activity and prevent the resistance of other antibiotics when used in combination. The risks of aminoglycosides are that they can damage the kidneys and the ears and that they can cause allergic reactions or interactions with other drugs. Therefore, the use of aminoglycosides should be balanced between the benefits and the risks, and the optimal dose and duration of treatment should be determined based on the type and location of the infection, the susceptibility of the bacteria, and the patient’s condition and response. The use of aminoglycosides should also be monitored closely, and any signs and symptoms of toxicity, side effects, or complications should be reported and treated promptly. The use of aminoglycosides should also be limited to the cases where they are necessary and appropriate, and they should not be used for minor or viral infections, or for prophylaxis or empiric therapy.
Importance of Proper Medical Supervision and Monitoring
Aminoglycosides are not drugs that can be taken lightly or casually, as they can have serious and potentially life-threatening consequences. Therefore, the use of aminoglycosides should be under the proper medical supervision and monitoring, and the patient should follow the instructions of the healthcare provider and take the medication as prescribed. The patient should also be educated about the importance of adherence, the recognition and reporting of side effects, and follow-up appointments and monitoring. The patient should also be informed about the research on new aminoglycosides, and the emerging trends in antibiotic therapy, and be encouraged to participate in clinical trials or studies, if eligible and interested. The patient should also be aware of the role and responsibility of the patient in antibiotic stewardship, and the prevention and control of antibiotic resistance. The patient should also be supported and empowered to take an active part in their own care and to communicate with the healthcare provider and the healthcare team. The use of aminoglycosides should be a collaborative and informed decision, and a shared responsibility, between the patient and the healthcare provider.
FAQ
01. What are aminoglycosides drugs?
Aminoglycosides are a class of antibiotics that are used to treat serious infections caused by bacteria that are difficult to treat with other antibiotics. Aminoglycosides work by binding to the bacterial ribosomes and inhibiting protein synthesis, leading to the death or weakening of the bacteria.
02. What are the 4 aminoglycosides?
There are many types of aminoglycosides, but the four most commonly used ones are gentamicin, tobramycin, amikacin, and streptomycin.
03. Why is it called aminoglycoside?
Aminoglycosides are called so because they have a chemical structure that consists of an amino-modified sugar (glycoside) linked to a central 2-deoxystreptamine ring.
04. Is azithromycin an aminoglycosides?
No, azithromycin is not an aminoglycoside. Azithromycin is a macrolide antibiotic, which means that it has a chemical structure that consists of a large lactone ring with one or more sugars attached.
05. What are the 7 aminoglycosides?
There are more than seven types of aminoglycosides, but some of the less common ones are neomycin, kanamycin, netilmicin, paromomycin, and spectinomycin.
06. What class of drugs are aminoglycosides?
Aminoglycosides belong to the class of drugs called bactericidal antibiotics, which means that they kill the bacteria rather than just stopping their growth.
07. Is azithromycin a macrolide or aminoglycoside?
Azithromycin is a macrolide antibiotic, not an aminoglycoside. Macrolides and aminoglycosides are different classes of antibiotics that have different structures, mechanisms of action, spectra of activity, and side effects.
08. What type of antibiotic is azithromycin?
Azithromycin is a type of antibiotic that belongs to the macrolide group. Macrolides work by binding to the bacterial ribosomes and inhibiting protein synthesis, leading to the weakening or death of the bacteria. Macrolides are effective against many gram-positive and some gram-negative bacteria, as well as some atypical bacteria, such as Mycoplasma, Chlamydia, and Legionella.
09. Is clarithromycin a aminoglycosides?
No, clarithromycin is not an aminoglycoside. Clarithromycin is also a macrolide antibiotic, similar to azithromycin.
10. Who should not take azithromycin?
Azithromycin should not be taken by people who are allergic to azithromycin or other macrolides, or who have liver or kidney problems, heart rhythm disorders, or a history of long QT syndrome. Azithromycin should also be used with caution by people who are taking other medications that can interact with azithromycin, such as warfarin, digoxin, cyclosporine, or antacids.
11. Why azithromycin is given for 3 days only?
Azithromycin is given for 3 days only for some infections, such as acute bacterial sinusitis, acute bacterial exacerbations of chronic bronchitis, or community-acquired pneumonia. This is because azithromycin has a long half-life, which means that it stays in the body for a long time after the last dose. Therefore, a short course of azithromycin can achieve the same effect as a longer course of other antibiotics.
12. Is azithromycin banned in India?
No, azithromycin is not banned in India. However, the Indian government has issued a warning against the indiscriminate use of azithromycin, especially for COVID-19, as this can lead to the emergence of resistant bacteria and reduce the effectiveness of azithromycin and other antibiotics.
13. Is azithromycin a bad antibiotic?
No, azithromycin is not a bad antibiotic. Azithromycin is a widely used and effective antibiotic that can treat many infections, such as respiratory, skin, ear, eye, and sexually transmitted infections. However, like any antibiotic, azithromycin can also have some side effects, such as nausea, vomiting, diarrhea, abdominal pain, headache, rash, or allergic reactions. Azithromycin can also cause some serious but rare complications, such as liver damage, hearing loss, or cardiac arrhythmias. Therefore, azithromycin should be used only when prescribed by a healthcare provider, and according to the instructions and precautions.
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