title: Rational use of aminoglycosides--review and recommendations by the Swedish Reference Group for Antibiotics (SRGA).
abstract: The Swedish Reference Group for Antibiotics (SRGA) has carried out a risk-benefit analysis of aminoglycoside treatment based on clinical efficacy, antibacterial spectrum, and synergistic effect with beta-lactam antibiotics, endotoxin release, toxicity, and side effects. In addition, SRGA has considered optimal dosage schedules and advice on serum concentration monitoring, with respect to variability in volume of drug distribution and renal clearance. SRGA recommends that aminoglycoside therapy should be considered in the following situations: (1) progressive severe sepsis and septic shock, in combination with broad-spectrum beta-lactam antibiotics, (2) sepsis without shock, in combination with broad-spectrum beta-lactam antibiotics if the infection is suspected to be caused by multi-resistant Gram-negative pathogens, (3) pyelonephritis, in combination with a beta-lactam or quinolone until culture and susceptibility results are obtained, or as monotherapy if a serious allergy to beta-lactam or quinolone antibiotics exists, (4) serious infections caused by multi-resistant Gram-negative bacteria when other alternatives are lacking, and (5) endocarditis caused by difficult-to-treat pathogens when monotherapy with beta-lactam antibiotics is not sufficient. Amikacin is generally more active against extended-spectrum beta-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli than other aminoglycosides, making it a better option in cases of suspected infection caused by multidrug-resistant Enterobacteriaceae. Based on their resistance data, local drug committees should decide on the choice of first-line aminoglycoside. Unfortunately, aminoglycoside use is rarely followed up with audiometry, and in Sweden we currently have no systematic surveillance of adverse events after aminoglycoside treatment. We recommend routine assessment of adverse effects, including hearing loss and impairment of renal function, if possible at the start and after treatment with aminoglycosides, and that these data should be included in hospital patient safety surveillance and national quality registries.
authors.affiliation: Department of Clinical and Experimental Medicine, Infectious Diseases, Faculty of Health Sciences, Linköping University, Linköping, Sweden. hakan.hanberger@liu.se
authors.forename: Håkan
authors.initials: H
authors.lastname: Hanberger
authors.forename: Charlotta
authors.initials: C
authors.lastname: Edlund
authors.forename: Mia
authors.initials: M
authors.lastname: Furebring
authors.forename: Christian
authors.initials: C
authors.lastname: G Giske
authors.forename: Asa
authors.initials: A
authors.lastname: Melhus
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
authors.forename: Johan
authors.initials: J
authors.lastname: Petersson
authors.forename: Jan
authors.initials: J
authors.lastname: Sjölin
authors.forename: Anders
authors.initials: A
authors.lastname: Ternhag
authors.forename: Maria
authors.initials: M
authors.lastname: Werner
authors.forename: Erik
authors.initials: E
authors.lastname: Eliasson
mesh_terms: D000617:Aminoglycosides / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D006801:Humans; D017410:Practice Guidelines as Topic; D013548:Sweden
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents