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While aminoglycosides are an older class of medication, they continue to be clinically valuable. Aminoglycosides have a broad spectrum of activity covering aerobic organisms, including gram-negative bacteria and mycobacteria. There are several drugs within the aminoglycoside class, including gentamicin, tobramycin, amikacin, neomycin, plazomicin, and streptomycin, and FDA-approved indications vary between the for these individual aminoglycosides. This activity reviews the indications, contraindications, mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent to members of the interprofessional team who wish to prescribe aminoglycosides. Objectives: Describe the mechanism of action of the aminoglycosides. Outline the indications for different aminoglycosides. Summarize the adverse effects and monitoring requirements of aminoglycosides. Explain the importance of antimicrobial stewardship and how it affects antimicrobial selection as it pertains to improving care coordination among the interprofessional team when initiating aminoglycoside therapy. Access free multiple choice questions on this topic.

There is no antidote for the toxicities of aminoglycosides. However, agents with protective effects on the ear and kidney may help prevent aminoglycoside-induced toxicity.  In particular, N-acetylcysteine demonstrates promising protective effects on patients using aminoglycosides.[16]

Evaluating the need for aminoglycoside therapy requires a holistic approach by an interprofessional team of professional individuals, including but not limited to physicians, specialists, nurses, pharmacists, laboratory technologists, audiometric technicians, and social workers, to achieve optimal outcomes. [Level V] Physicians and pharmacists have a critical role in determining the need for empiric treatment or directed treatment with an aminoglycoside.  Both healthcare professionals need to utilize communication and their expertise to determine if and which aminoglycoside is necessary, what is the correct dosing, and what is the optimal duration of therapy.  Therapeutic dose monitoring should also be done for the patient to achieve the best results with aminoglycoside treatment. In many institutions, the clinician initiates aminoglycoside therapy, and the clinical pharmacist handles all the dosing and subsequent adjustments, using kinetic dosing criteria. When in the hospital, nurses must assess for any potential toxicities developing in a patient. Because toxicity outcome typically depends on early detection, healthcare professionals need to monitor patients for any adverse signs and communicate with the team for the next step in therapy. Nurses will administer the drug and should be alert to signs of toxicity, interactions, and therapeutic effectiveness. Laboratory technologists and audiometric technicians are essential for checking serum creatinine in all patients and performing audiometry. Lastly, the role of a social worker is significant in preparing a patient for discharge while still on aminoglycoside therapy. All healthcare disciplines working as part of the interprofessional teams have their roles to play, making communication and collaboration key in providing patients with the best outcome care leading to optimal outcomes. [Level V]