Aminoglycoside Antibiotics: Clinical Use and Guidelines

Introduction to Aminoglycosides

The American College of Cardiology and other guideline societies recommend the use of aminoglycosides, including gentamicin, tobramycin, amikacin, streptomycin, kanamycin, and neomycin, in clinical practice for various infections 1

For plague treatment, the CDC recommends streptomycin and gentamicin as FDA-approved aminoglycosides with similar efficacy profiles 6
For endocarditis, the American Heart Association recommends gentamicin at 3 mg/kg per 24 hours IV/IM in 3 equally divided doses, in combination with cell wall-active agents, with streptomycin as an alternative when gentamicin resistance is present 3, 5
For drug-resistant tuberculosis, the World Health Organization recommends the use of amikacin, kanamycin, streptomycin, and other injectables 2
For urologic procedures, the American Urological Association recommends gentamicin, tobramycin, or amikacin as options for prophylaxis 4
For sepsis and septic shock, the Society of Critical Care Medicine recommends gentamicin equivalent at 5-7 mg/kg daily for once-daily dosing in patients with preserved renal function 7

The American Journal of Respiratory and Critical Care Medicine notes that streptomycin has a distinct core ring structure, explaining why cross-resistance between streptomycin and other aminoglycosides is uncommon 2
All E. faecium are intrinsically resistant to amikacin, kanamycin, netilmicin, and tobramycin, while E. faecalis are often resistant to kanamycin and amikacin 5
Strains resistant to gentamicin may remain susceptible to streptomycin due to different resistance mechanisms 3, 5

The American Journal of Respiratory and Critical Care Medicine states that all aminoglycosides share three key characteristics: concentration-dependent killing, a post-antibiotic effect, and synergism with other antibacterial drugs 2
Single daily dosing is now preferred over traditional multiple daily dosing for most indications due to equal or better efficacy and reduced toxicity risk 1