Aminoglycoside Use in Serious Bacterial Infections

Indications and Dosing

Aminoglycosides are recommended as part of combination therapy for initial treatment of patients with severe pneumonic or septicemic plague, according to the Centers for Disease Control and Prevention 2
Aminoglycosides have shown superior outcomes compared to tigecycline-containing regimens for carbapenem-resistant Enterobacterales (CRE) infections, particularly for complicated urinary tract infections, with a strength of evidence rated as high 3, 4, 5
Once-daily dosing (5-7 mg/kg daily gentamicin equivalent) is recommended for patients with preserved renal function to optimize peak drug plasma concentrations, as suggested by the Critical Care Medicine society 1
For gentamicin in adults, a dose of 5 mg/kg every 24 hours IV or IM is recommended, according to the Centers for Disease Control and Prevention 2
For tobramycin in adults, a dose of 5-7 mg/kg every 24 hours IV or IM is recommended, according to the Centers for Disease Control and Prevention 2
For amikacin in adults, a dose of 15-20 mg/kg every 24 hours IV or IM is recommended, according to the Centers for Disease Control and Prevention 2
For children ≥1 month to ≤17 years, gentamicin 4.5-7.5 mg/kg every 24 hours IV or IM is recommended, according to the Centers for Disease Control and Prevention 2

Therapeutic drug monitoring is essential to minimize toxicity, primarily to ensure trough concentrations are sufficiently low to minimize renal toxicity, as recommended by the Critical Care Medicine society 1
In sepsis and septic shock, aminoglycosides should be initiated with a full, high-end loading dose to rapidly achieve therapeutic levels due to increased volume of distribution in these patients, according to the Critical Care Medicine society 1

Aminoglycosides are often recommended as part of combination therapy for empiric treatment of suspected or proven pseudomonas sepsis, as suggested by the European Society for Medical Oncology 6
For neonatal sepsis, aminoglycosides (usually gentamicin) combined with ampicillin or benzylpenicillin are recommended as first-line empiric treatment, according to the European Society of Clinical Microbiology and Infectious Diseases 7

Patients with chronically mildly impaired renal function should still receive a once-daily-equivalent dose but with an extended period (up to 3 days) before the next dose, as recommended by the Critical Care Medicine society 1
Once-daily dosing regimen should not be used in patients with severe renal dysfunction in whom the aminoglycoside is not expected to clear within several days, according to the Critical Care Medicine society 1
Aminoglycosides are not recommended for routine use in gastrointestinal infections due to toxicity concerns, as stated by the Infectious Diseases Society of America, although this fact is from 'Praxis Medical Insights', an alternative source is not available 8