Back to the Future: Using Aminoglycosides Again and How to Dose Them Optimally

摘要: Gram-negative organisms have become increasingly resistant to both b-lactam antibiotics and fluoroquinolones. Consequently, aminoglycoside undergone a resurgence in use. Because of the known toxicities antibiotics, clinicians avoided their use, unless no other alternatives were extant. Over past 2 decades, we learned much about relationship between exposure likelihood good clinical outcome or occurrence nephrotoxicity. For example, minimum inhibitory concentration values 2.0 mg/L lead unacceptably low probabilities outcome, infrequent administration doses (i.e., intervals 24 h longer for patients with compromised renal function) plays central role minimizing toxicity. Using these new insights, suggest ways evaluating dose schedule aminoglycosides empirical therapy obtain highest an efficacious nontoxic therapy. Nosocomial infections caused by gram-negative bacilli difficult treat over 5 years because advent number resistance mechanisms that limit use some best drugs our armamentarium. Unfortunately, very few are active against multidrug-resistant nosocomial expected be available 5‐10 years. many starting again consider antibiotics. The commentary this article applies only organisms. Aminoglycosides widely used throughout 1970s 1980s. generates toxicities, mostly oto- It was noted [1] intensive care units who developed altered function had significantly increased risk death. broad-spectrum b-lactams (e.g., third- fourthgeneration cephalosporins; b-lactamase inhibitor combinations, such as piperacillin tazobactam; carbapenems, imipenem plus cilastatin meropenem)