Aminoglycosides are the antibiotics used to treat severe infections. Includes drugs Streptomycin, Amikacin, Gentamycin, Tobramycin and neomycin

16. ANTIBIOTICS: AMINOGLYCOSIDES
DRUG NAME gentamicin, streptomycin, amikacin, neomycin, tobramycin
MECHANISM OF ACTION
Protein synthesis inhibitors: bind to the 30S ribosomal subunit, thereby interfering with protein synthesis and
resulting in bacterial death
INDICATIONS
•Severe systemic infections caused by Gram negative bacteria
•Miscellaneous uses:
• Tuberculosis (streptomycin)
• Topical treatment of eye infections (tobramycin and gentamicin)
• Respiratory Pseudomonas infection in clients with cystic fibrosis (tobramycin)
• Hepatic encephalopathy and preoperative bowel antiseptic (neomycin)
ROUTE(S) OF
ADMINISTRATION
•Gentamicin: IM, IV, TOP
•Streptomycin: IM
•Amikacin: IM, IV
•Neomycin: PO
•Tobramycin: IM, IV, TOP, NEB
SIDE EFFECTS
•Post-antibiotic effect
•High risk of toxicity
•Skin rash, urticaria, photosensitivity, alopecia
•Anorexia, nausea, vomiting, diarrhea
•Hepatotoxicity, Bone marrow suppression, higher risk for infections
•Weakness, paralysis
•Boxed warnings: nephrotoxicity, neurotoxicity
CONTRAINDICATIONS
AND CAUTIONS
•Renal or hepatic disease, Pre-existing hearing loss
•Active infections
•Myasthenia gravis and parkinsonism
•Pregnancy and breastfeeding, Elderly clients
•Combination with loop diuretics

17. ANTIBIOTICS: AMINOGLYCOSIDES
ASSESSMENT AND
MONITORING
•History of hearing or balance problems
•Assess: weight, vital signs, hydration status
•Review their medication list for other ototoxic, nephrotoxic medications
•Laboratory test results: renal and liver function tests, CBC, culture and sensitivity
urinalysis, negative pregnancy test
•Confirm dosage calculation in mg / kg / day
•Ensure adequate hydration before administration
•Infuse the gentamicin over 30 minutes to one hour
•Monitor
• Vital signs
• Signs of nephrotoxicity: I&O, renal function tests, urinalysis
• Client report of neurotoxicity: tinnitus (ringing or buzzing in their ears); dizziness,
vertigo, headache
• Opportunistic infections, Clostridioides
•Draw trough level one hour before the next daily dose; hold if more than two mcg / mL
•Evaluate therapeutic response
CLIENT EDUCATION
•Purpose of medication: treat infection
•Administered intravenously once each day
•Close monitoring to decrease risk of side effects
•Report symptoms of neurotoxicity