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- The aminoglycosides are among the most active antibiotics against aerobic gram-negative bacilli, including Pseudomonas aeruginosa
- There are eight drugs in this class, but clinically relevant are genatmicin, tobramycin, and amikacin.
- Bind to 30s ribosome (erythromycin binds 50s ribosome)
- Penetrate CSF poorly
- Metabolism does not occur in the host and is excreted in the urine by glomerular filtration
- ototoxicity related to high-peak levels( can produce irreversible hearing loss and vestibular damage)
- nephrotoxicity in up to 20% ( enhanced by hypovolemia, hypokalemia, hypomagnesemia, preexistent renal disease, old age, concurrent treatment with other nephrotoxic agents)
- Cylindrical casts in the urine, proteinuria, and inability to concentrate are early signs of toxicity, followed by serum rise of creatinine
- neuromuscular blockade ( aminoglycosides should be avoided in myasthenia gravis)
- Once-daily dosing based on body weight is equivalent to divided-dose regimens in efficacy and toxicity, but less costly and time consuming.