Aminoglycosides

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Aminoglycosides

Origin

Streptomycin sulfate which is the first aminoglycoside available for clinical use derived from the bacterium Streptomyces griseus in 1944.

Indications

Aminoglycosides are for serious infections, and currently used to treat pseudomonas aeruginosa infection include gentamicin, tobramycin, and amikacin. They are almost exclusively used to treat gram negative infections but are also used in lower doses in addition to beta lactams (ie. nafcillin) to provide a synergistic effect. A common place for this is in the treatment of endocarditis. In combination with gentamicin or streptomycin, penicillin G and ampicillin facilitate the intracellular uptake of the aminoglycoside, which causes the subsequent bactericidal effect against the enterococci.

·         Amikacin sulfate (Amikin): effective against gram-negative bacteria, including those resistant to other aminoglycosides. Used for respiratory tract, bone joint, skin, and soft-tissue infections.

·         Gentamicin sulfate (Ganamycin): To treat serious infections caused by gram-negative organisms (e.g., Pseudomonas aeruginosa, Proteus); to trat pelvic inflammatory disease; effective against methicillin-resistant Staphylococcus aureus infections.

·         Kanamycin sulfate (Kantrex): used orally for hepatic coma. Effective against gram-negative bacteria with the exception of Pseudomonas aeruginosa.

·         Neomycin sulfate Myciguent (Neo-Fradin): decreases bacteria in the bowel and is used as a preoperative bowel antiseptic. Treats skin infections and diarrhea caused by E. coli.

·         Streptomycin sulfate (Streptomycin): for tuberculosis.

·         Tobramycin sulfate (Nebcin): very effective against Pseudomonas aeruginosa.

Actions

Inhibition of bacterial protein synthesis; actericidal effect

Route & Dosage

·         Amikacin sulfate (Amikin)

—         A/: IM/IV: 10 to 15 mg/kg/d q8 to 12h; max: 15 mg/kg/d

—         C: IM/IV: 7.5 to 22.5mg/kg/d in divided doses; max:15 mg/kg/d

—         TDM: peak: 25 to 35 mcg/mL; trough: < 5 mg/ml

·         Gentamicin sulfate (Ganamycin)

—         A: IM/IV: 3 to 6 mg/kg/d in 2 to 3 in divided doses

—         C: IM/IV: 2 to 2.5mg/kg q8h

—         TDM: peak: 5 to 8 mcg/mL; trough: 0.5 to 2 mcg/ml

·         Kanamycin sulfate (Kantrex):

—         A/C: IM/IV: 10 to 15mg/kg/d in divided doses

·         Neomycin sulfate Myciguent (Neo-Fradin)

—         Bowel prep: A: PO: 1 g q1h for 4 doses; then 1 g q4h for 5 doses

—         Hepatic coma: A: PO: 1 to 3 g q6h for 5 to 6 d; max: 12 g/d

·         Streptomycin sulfate (Streptomycin)

—         A: IM: 1 to 2 g/d

—         C: IM: 20 to 40 mg/kg/d

—         TDM: peak: 20 to 35 mcg/dL; trough: <10 mcg/mL

·         Tobramycin sulfate (Nebcin):

—         A: IM/IV: 3 to 5 mg/kg/d in divided doses

—         C: IM/IV: 2.5mg/kg/d in divided doses

—         TDM: peak: 4 to 8 mcg/dL; trough: 0.5 to 2 mcg/mL

Side effects

·         Ototoxicity: damage to the ear and hearing

·         Nephrotoxicity: kidney damage

·         Photosensitivity

·         Nausea, vomiting, tremors, tinnitus, pruritus, and muscle cramps.

Contraindications

Hypersensitivity, severe renal disease, pregnancy, and breastfeeding

Nursing Process

Assessment

Record vital signs and urine output. Compare these results with future vital signs and urine output. An adverse reaction to most aminoglycosides in nephrotoxicity.

Check laboratory results, especially those that indicate renal and liver function (serum creatinine, blood urea nitrogen, alkaline phosphatase, alanine aminotransferase, asparate aminotransferase, and bilirubin)

Obtain a medical history related to renal or hearing disorders. Large doses of aminoglycosides could cause nephrotoxicity or ototoxicity.

Nursing Interventions

·         Due the high risk nature of these drugs, daily monitoring of serum creatinine.

Send sample from infected area to laboratory for culture to determine organism and antibiotic sensitivity before aminoglycoside is started.

Monitor intake and output. Urine output should be at least 600 mL/d. Immediately report if urine output is decreased. Urinalysis may be ordered daily. Check results for proteinuria, casts, blood cells, or appearance.

Check for hearing loss. Aminoglycosides can cause ototoxicity.

Evaluate laboratory results and compare with baseline values. Report abnormal results.

Monitor vital signs. Note if body temperature has decreased.

Patient teaching

·         General

Unless fluids are restricted, encourage client to increase fluid intake.

Instruct client never to take leftover antibiotics.

·         Side effects

Inform client to report aminoglycoside side effects: nausea, vomiting, tremors, tinnitus, pruritus, and muscle cramps.

Direct client to use sun block and protective clothing during sun exposure. Photosensitivity can be caused by aminoglycosides.

References

Kee, J., Hayes, E., & McCuistion, L. (2012). Pharmacology: a nursing process approach (7^th ed.). St. Louis, MO: Elsevier.

Radigan, E. A., Gilchrist, N. A., & Miller, M. A. (2010). Management of Aminoglycosides in the Intensive Care Unit. Journal Of Intensive Care Medicine (Sage Publications Inc.), 25(6), 327-342. doi:10.1177/0885066610377968