Aminoglycosides adverse reactions

Aminoglycoside Adverse Reactions (%) Amikacin Gentamicin Kanamycin... 

Discuss the uses, general drug action, contraindications, precautions, interactions, and adverse reactions of the fluoroquinolones and aminoglycosides. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of a fluoroquinolone or aminoglycoside. 

Additional adverse reactions seen with administration of the aminoglycosides may include nausea, vomiting, anorexia, rash, and urticaria When these drugs are given, individual drug references, such as the package insert, should be consulted for more specific adverse reactions. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

The aminoglycosides are potentially neurotoxic, nephrotoxic, and ototoxic and are capable of causing permanent damage to tiiese organs and structures. The nurse notifies the primary health care provider immediately when one or more signs and symptoms of tiiese adverse reactions is suspected. 

Vancomycin can cause red-man syndrome consisting of diffuse flushing, presumably mediated by histamine-release. This problem can be prevented by limiting the infusion rate. The most serious adverse reactions are ototoxicity and nephrotoxicity. The toxicity for both organ systems is potentiated by aminoglycosides. Vancomycin will cross the placenta barrier and has the potential to cause fetal ototoxicity. 

It is important to monitor peak and trough plasma levels (see p. 20) of gentamicin, tobramycin, netilmicin, and amikacin to avoid concentrations that cause dose-related toxicities (Figure 31.7). [Note Peak levels are defined as those obtained 1/2 to 1 hour after infusion. Trough levels are obtained immediately before the next dose.] Patient factors, such as old age, previous exposure to aminoglycosides, gender, and liver disease, tend to predispose patients to adverse reactions. The elderly are particularly susceptible to nephrotoxicity and ototoxicity. 

All the aminoglycosides have similar patterns of adverse reactions, although there are important differences with regard to their frequency and severity (Table 1). 

The main adverse reactions of aminoglycosides consist of kidney damage (often presenting as non-ohguric renal insufficiency) and ototoxicity, including vestibular and/ or cochlear dysfunction. Neuromuscular transmission can be inhibited. Hypersensitivity reactions are most frequent after topical use, which should be avoided. Anaphylactic reactions can occur. Tumor-inducing effects have not been reported. 

Adverse effects might be produced when aminoglycosides are administered with other medications. Here are potential adverse reactions ... 

Adverse reactions to aminoglycosides, including nephrotoxicity, ototoxicity, and neuromuscular blockade, in patients in intensive care have been reviewed [3 ]. The use of a high-dose extended interval dosing regimen may reduce the incidence of acute kidney damage in one study the incidence was 1.2%, which is lower than the previously reported rate of 3-5%. 

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