Aminoglycosides management

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. 

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. 

Monitoring and Managing Adverse Drug Reactions Aminoglycosides... 

A good example is neomycin, which is one of the least well absorbed of the aminoglycosides and has a place as an oral drug in the management of hepatic failure - probably because it acts locally and reduces the bacterial load of the large bowel. 

Initial experiences with aerosolized antimicrobial therapies appeared in the literature more than 50 years ago. Until the early 1990s, the quality of the evidence supporting this strategy in the management of lung infections was poor. Recently, results from well-controlled clinical trials have established a role for inhaled antibiotics, particularly aminoglycosides, as suppressive therapy for patients with cystic fibrosis. Cyclic therapy with inhaled tobramycin reduces the frequency of pulmonary exacerbations and improves lung function. 

Nephrotoxicity has been reported in 1.7% to 58% of patients receiving aminoglycoside therapy. The large variance is in part due to the use of different definitions of toxicity, variability between agents in the class, as well as the risk factors in the study population. The management of nephrotoxicity, a major contributor to the total cost of aminoglycoside therapy, was estimated to be over 4500 per case in the late 1990s. 

Peak and/or trough concentrations are monitored rontinely for only a select few antimicrobials (e.g., aminoglycosides and vancomycin) during the contemporary management of infections. It is crucial for the health care team to ensure that the antimicrobiars administration time and serum sample time(s) are meticulously recorded because even small errors in recording these (e.g., 1 hour) may have a substantial impact on the calcnlation of pharmacokinetics for antibiotics such as the aminoglycosides, which have relatively short elimination half-lives. 

Electrolyte imbalance, and diseases that lead to electrolyte imbalance, such as adrenal cortical insufficiency, alter neuromuscular blockade. Depending on the nature of the imbalance, either enhancement or inhibition may be expected. Magnesium sulfate, used in the management of toxemia of pregnancy, enhances the skeletal-muscle-relaxing effects of pancuronium. Antibiotics such as aminoglycosides, tetracyclines, clindamycin, lincomycin, colistin, and sodium colistimethate augment the pancuronium-induced neuromuscular blockade. Anesthetics such as halothane, enflurane, and isoflurane enhance the action of pancuronium, whereas azathioprine will cause a reversal of neuromuscular blockade. 

Paromomycin, an aminoglycoside with antibacterial and amebicidal properties, is indicated in the treatment of acute and chronic intestinal amebiasis, of tapeworm (fish, beef, pork, and dog) infections in patients who cannot take praziquantel or niclosamide, and as an adjunctive regimen in the management of hepatic coma. 

In penicillin-allergic patients, vancomycin is an effective alternative for the treatment of endocarditis caused by viridans streptococci or, combined with an aminoglycoside, for enterococcal endocarditis. Vancomycin has become an important antibiotic in the management of known or suspected penicillin-resistant pneumococcal infections. 

Radigan EA, Gilchrist NA, Miller MA. Management of aminoglycosides in the intensive care unit. J Intensive Care Med 2010 25(6) 327-42. 

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