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Article: Parenteral aminoglycoside therapy: Selection, administration and monitoring

TitleParenteral aminoglycoside therapy: Selection, administration and monitoring
Authors
Issue Date1994
PublisherAdis International Ltd. The Journal's web site is located at http://drugs.adisonline.com/
Citation
Drugs, 1994, v. 47 n. 6, p. 902-913 How to Cite?
AbstractAminoglycosides are potent water-soluble antibiotics, with peak concentration-dependent bactericidal activity against many pathogenic aerobic Gram-negative bacilli and Staphylococcus aureus. For systemic therapy, they must be given parenterally (intravenously or intramuscularly). In the body they remain largely extracellular, but penetration into cerebrospinal fluid and other secretions is meagre. They display trough concentration-dependent reversible nephrotoxicity and the commonly irreversible ototoxicity, which may present after treatment ceases. Gentamicin is the usual all-purpose agent of choice, tobramycin is slightly more effective against Pseudomonas aeruginosa infections, amikacin is the least susceptible to degradation by bacterial enzymes and netilmicin is probably the least toxic. Clinical and drug concentration monitoring have a role in therapy. Aminoglycosides exhibit enduring antibacterial activity (especially against Gram-negative bacilli) many hours after tissue concentrations become negligible. Appreciation of this postantibiotic effect is leading to replacement of conventional multiple daily doses by large single daily doses. The latter regimens confer at least equivalent efficacy and less risk of toxicity (particularly renal). However, single daily dosage may be unsuitable for immunocompromised patients and in those with infective-endocarditis, where-there is insufficient experience. Cotreatment with β-lactams is commonly used in order to exploit the synergism between these agents, particularly in enterococcal endocarditis and severe Gram-negative sepsis. Liposomal aminoglycosides are promising parenteral formulations. After being taken up by phagocytes they reach the liver, spleen and sites of inflammation; subsequently they are gradually released. To substantiate the applicability of these hitherto experimental formulations, findings from clinical studies are keenly awaited.
Persistent Identifierhttp://hdl.handle.net/10722/157269
ISSN
2015 Impact Factor: 4.883
2015 SCImago Journal Rankings: 1.601
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKumana, CRen_US
dc.contributor.authorYuen, KYen_US
dc.date.accessioned2012-08-08T08:48:32Z-
dc.date.available2012-08-08T08:48:32Z-
dc.date.issued1994en_US
dc.identifier.citationDrugs, 1994, v. 47 n. 6, p. 902-913en_US
dc.identifier.issn0012-6667en_US
dc.identifier.urihttp://hdl.handle.net/10722/157269-
dc.description.abstractAminoglycosides are potent water-soluble antibiotics, with peak concentration-dependent bactericidal activity against many pathogenic aerobic Gram-negative bacilli and Staphylococcus aureus. For systemic therapy, they must be given parenterally (intravenously or intramuscularly). In the body they remain largely extracellular, but penetration into cerebrospinal fluid and other secretions is meagre. They display trough concentration-dependent reversible nephrotoxicity and the commonly irreversible ototoxicity, which may present after treatment ceases. Gentamicin is the usual all-purpose agent of choice, tobramycin is slightly more effective against Pseudomonas aeruginosa infections, amikacin is the least susceptible to degradation by bacterial enzymes and netilmicin is probably the least toxic. Clinical and drug concentration monitoring have a role in therapy. Aminoglycosides exhibit enduring antibacterial activity (especially against Gram-negative bacilli) many hours after tissue concentrations become negligible. Appreciation of this postantibiotic effect is leading to replacement of conventional multiple daily doses by large single daily doses. The latter regimens confer at least equivalent efficacy and less risk of toxicity (particularly renal). However, single daily dosage may be unsuitable for immunocompromised patients and in those with infective-endocarditis, where-there is insufficient experience. Cotreatment with β-lactams is commonly used in order to exploit the synergism between these agents, particularly in enterococcal endocarditis and severe Gram-negative sepsis. Liposomal aminoglycosides are promising parenteral formulations. After being taken up by phagocytes they reach the liver, spleen and sites of inflammation; subsequently they are gradually released. To substantiate the applicability of these hitherto experimental formulations, findings from clinical studies are keenly awaited.en_US
dc.languageengen_US
dc.publisherAdis International Ltd. The Journal's web site is located at http://drugs.adisonline.com/en_US
dc.relation.ispartofDrugsen_US
dc.subject.meshAminoglycosidesen_US
dc.subject.meshAnimalsen_US
dc.subject.meshAnti-Bacterial Agents - Administration & Dosage - Adverse Effects - Pharmacokineticsen_US
dc.subject.meshBacterial Infections - Drug Therapyen_US
dc.subject.meshDrug Administration Scheduleen_US
dc.subject.meshDrug Carriersen_US
dc.subject.meshDrug Synergismen_US
dc.subject.meshHumansen_US
dc.subject.meshInjections, Intramuscularen_US
dc.subject.meshInjections, Intravenousen_US
dc.subject.meshLiposomesen_US
dc.subject.meshRandomized Controlled Trials As Topicen_US
dc.titleParenteral aminoglycoside therapy: Selection, administration and monitoringen_US
dc.typeArticleen_US
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_US
dc.identifier.authorityYuen, KY=rp00366en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid7521830en_US
dc.identifier.scopuseid_2-s2.0-0028214052en_US
dc.identifier.volume47en_US
dc.identifier.issue6en_US
dc.identifier.spage902en_US
dc.identifier.epage913en_US
dc.identifier.isiWOS:A1994NP08400004-
dc.publisher.placeNew Zealanden_US
dc.identifier.scopusauthoridKumana, CR=7005112381en_US
dc.identifier.scopusauthoridYuen, KY=36078079100en_US

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