For years, aminoglycosides have remained a useful antimicrobial tool because of the relatively slow development of bacterial resistance and their low cost.Their antimicrobial spectrum predominantly ...includes aerobic gram-negativebacteria, but they act synergistically against gram-positive bacteria as well, and some are active against mycobacteria. Nowadays, aminoglycosides are rarely used against gram- negative bacteria as a monotherapy; they are usually combined with beta-lactams and glycopeptides to accelerate the bactericidal effect and slow down the development of resistance. Clinical studies supporting the use of aminoglycosides in combination are rare. Most often, aminoglycosides are used in a combination for severe Pseudomonas aeruginosa infections, some other gram-negative and staphylococcal infections, febrile neutropenia and endocardicis. Aminoglycosides have a relatively narrow therapeutic index and their most important toxic effects are nephrotoxicity and ototoxicity. Due to a good pharmacodynamic effect of high doses, the postantibiotic effect and probably lower toxicity of less frequent larger doses, once-daily dosage of aminoglycosides has become increasingly popular in recent years. Once-daily aminoglycoside dosage has been studied in many clinical trials. These have confirmed the equal or lower toxicity and equal efficacy of their once-daily dosage in comparison with the traditional aminoglycoside dosage. However, thistype of dosage is still not recommended fox certain groups of patients andfor some infections for which its efficacy has not yet been tested. Since aminoglycosides are toxic and their dosage largely depends on the underlying disease, especially renal failure all treatment with aminoglycosides should becarefully planned and monitored.
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