title: Aminoglycosides: how should we use them in the 21st century?
abstract: OBJECTIVE
  Aminoglycoside antibiotics (AGAs) have proved an invaluable part of our antimicrobial armamentarium since their introduction into practice over 60 years ago. This review summarizes recent developments, defining their role in the context of the current global epidemic of antibiotic resistance, raising awareness of their toxicity profile, and highlighting current data on their utility as synergistic agents.
  
  
  RESULTS
  Clinicians are facing an unprecedented threat from antibiotic resistance, resulting in an increased reliance on the addition of an AGA to provide adequate empirical cover in cases of severe sepsis. Concurrently, an increased awareness of the potential for severe disability, particularly from vestibular toxicity, has restrained directed therapy of AGAs to situations in which there are no appropriate alternatives. Their role as synergistic agents in the treatment of enterococcal endocarditis is currently under reevaluation, and new data have emerged on combination therapy for Pseudomonas aeruginosa bacteremia. AGAs are themselves coming under increasing threat from resistance, predominately from aminoglycoside modifying enzymes (mediating selective resistance) and 16S rRNA methyltransferases (conferring class-wide resistance). New agents and the development of alternate ways to circumvent resistance are likely to have important roles in future clinical care.
  
  
  CONCLUSIONS
  Aminoglycosides retain an invaluable but well defined role, and will remain important agents into the foreseeable future.
authors.affiliation: aDepartment of Infectious Diseases, St Vincent's Hospital bVictorian Infectious Disease Service, The Royal Melbourne Hospital cThe University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Jackson
authors.forename: Caroline
authors.initials: C
authors.lastname: Chen
authors.forename: Kirsty
authors.initials: K
authors.lastname: Buising
mesh_terms: D000617:Aminoglycosides / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000502:physiology; D006801:Humans
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents