Should aminoglycoside antibiotics be abandoned?
BACKGROUND
Aminoglycosides can cause nephrotoxicity and ototoxicity. Alternatives are available.


METHODS
Surgical service antibiotic use, aminoglycoside toxicity, and perioperative culture/sensitivity results from July 1998 to June 1999 were reviewed.


RESULTS
Of 289 positive cultures in 243 patients, 92 cultures (32%) grew 151 Gram-negative rods (GNRs). Aminoglycosides were used in 26 patients and 4 of 26 (15%) suffered nephrotoxicity. Of the 112 GNRs tested against ceftazidime, 111 (99%) were sensitive to it which was significantly better than amikacin (56 of 61, 92%, P = 0.038), gentamicin (116 of 134, 87%, P <0.001), and tobramycin (67 of 81, 83%, P <0.001). The proportion sensitive to cefuroxime (26 of 30, 87%) was equivalent to the proportions sensitive to gentamicin (87%, P = NS) and tobramycin (83%, P = NS). Of the 35 GNRs that were resistant to gentamicin and/or tobramycin, 15 (43%) were Pseudomonas aeruginosa.


CONCLUSIONS
Aminoglycosides produce a significant rate of nephrotoxicity. There are antibiotics with equal or better sensitivity profiles than aminoglycosides against GNRs and Pseudomonas. Aminoglycoside use is rarely, if ever, indicated.
English
W P
WP
Department of Surgery, University of Mississippi Medical Center, and the G. V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi 39216-5199, USA.
Williams
M D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology; D004363:Drug Utilization; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012189:Retrospective Studies
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents