AMINOGLYCOSIDES

Elizabeth Eggers Katie Fournier Tonya Hensley Jessica Sipes

Prototype:

Streptomycin

Action:

Inhibits the bacterial protein synthesis through binding to prokaryotic ribosomes. Several studies have shown that the site of action is actually the outer membrane of the bacteria.

Use:

It is a highly potent broad spectrum Antibiotic used to treat life-threatening infections.

  • Children: Neonates have an increased risk of neuromuscular blockade; difficulty in assessing auditory and vestibular function and immature renal function. Individualize the dose.
  • Older Adults: Difficulty in assessing auditory and vestibular function and age related renal impairment. Need to monitor renal function and individualize the dose.
  • Renal Impairment: May need to decrease the dose with blood level monitoring to prevent toxicity. With a urinary tract infection smaller doses can be used.
  • Hepatic Impairment: Use gentamicin and no adjustments in dosage or frequency indicated but monitor the plasma concentrations.
  • Critical Illness: At risk for developing nephrotoxicity and ototoxicity follow guidelines strictly. Preferred to use in combination with other antibacterial agents. Once the identified organism is known then a discontinuation of the aminoglycoside takes place and a less toxic antibiotic is the prescribed.
  • Home Care: Administration of gentamicin does not typically occur in the home. Instruction of IV care is essential for caregivers who are giving medication.

Adverse Effects:

· Renal toxicity
· Auditory loss of inner ear

· Vertigo

· Ataxia

· Neuromuscular blocker

· Dizziness/Unsteadiness

· Decreased appetite

· Increased thirst

· Muscle twitching/seizures

· Vomiting and Nausea

· Urine output changes

Contraindications:

· Allergic reactions

· Necrosis of liver

· Interfere with neuromuscular transmission

· Irreversible hearing loss

Nursing Implications:

For pregnancy it is the category D where the clinical implications will outweigh the risks, and are compatible for breastfeeding. Frequent doses are avoided because of the level of toxicity, which depends on the therapeutic level and the concentration rather than the peak level and being time dependent. A build up in the system can occur so they are given by IV only once a day over a course of around 30-45 minutes rather than in a higher dose. There is a need to monitor the serum level (trough level) because of these indications which is measured on the 2nd and 3rd doses given. A desired peak level is going to be 10 times the MIC. Examine for hypersensitivity teaching the patient what the signs and symptoms are to monitor for a reaction. Also, tell the patient that if taking at home they will need to take at the same time every day. Monitor for renal, hepatic, and neurotoxicity. When monitoring the renal impairment look at I&O and instruct the patient to drink fluids.
Observe for an infection and the reaction of the antibiotic on the microorganisms.

Other Drugs in Class:

These should only be used topically or orally:
  • Amikacin
  • Gentamicin
  • Kanamycin
  • Neomycin
  • Tobramycin
  • Paromomycin