Aminoglycosides Health Article

Definition

Aminoglycosides are a group of antibiotics that are used to treat certain bacterial infections. This group of antibiotics includes at least eight drugs: amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. All of these drugs have the same basic chemical structure.

Purpose

Aminoglycosides are primarily used to combat infections due to aerobic, Gram-negative bacteria. These bacteria can be identified by their reaction to Gram's stain. In Gram's staining, a film of material containing the possible bacteria is placed on a glass slide and dried. The slide is stained with crystal violet for one minute, cleaned off with water and then placed into a solution of Gram's iodine solution for one minute. The iodine solution is rinsed off and the slide is immersed in 95% ethyl alcohol. The slide is then stained again with reddish carbolfuchsin or safranine for 30 seconds, rinsed in water, dried and examined. Gram-positive bacteria retain the violet purple stain. Gram-negative bacteria accept the red stain. Bacteria that can successfully be combated with aminoglycosides include Pseudomonas, Acinetobacter, and Enterobacter species, among others. Aminoglycosides are also effective against mycobacteria, the bacteria responsible for tuberculosis.

The aminoglycosides can be used against certain Gram-positive bacteria, but are not typically employed because other antibiotics are more effective and have fewer side effects. Aminoglycosides are ineffective against anaerobic bacteria (bacteria that cannot grow in the presence of oxygen), viruses, and fungi. And only one aminoglycoside, paromomycin, is used against parasitic infection.

Like all other antibiotics, aminoglycosides are not effective against influenza, the common cold, or other viral infections.

Precautions

Pre-existing medical conditions—such as kidney disease, eighth cranial nerve disease, myasthenia gravis, and Parkinson's disease—should be discussed prior to taking any aminoglycosides. Pregnant women are usually advised against taking aminoglycosides, because their infants may suffer damage to their hearing, kidneys, or sense of balance. However, those factors need to be considered alongside the threat to the mother's health and life in cases of serious infection. Aminoglycosides do not pass into breast milk to any great extent, so nursing mothers may be prescribed aminoglycosides without injuring their infants.

Description

Streptomycin, the first aminoglycoside, was isolated from Streptomyces griseus in the mid-1940s. This antibiotic was very effective against tuberculosis. One of the main drawbacks to streptomycin is its toxicity, especially to cells in the inner and middle ear and the kidney. Furthermore, some strains of tuberculosis are resistant to treatment with streptomycin. Therefore, medical researchers have put considerable effort into identifying other antibiotics with streptomycin's efficacy, but without its toxicity.

Aminoglycosides are absorbed very poorly from the gastrointestinal tract; in fact, aminoglycosides taken orally are excreted virtually unchanged and undiminished in quantity. The route of drug administration depends on the type and location of the infection being treated. The typical routes of administration are by intramuscular (injection into a muscle) or intravenous injection (injection into a vein), irrigation, topical skin application, or inhalation. If the infection being treated involves the central nervous system, the drug can be injected into the spinal canal.

The bactericidal ability of aminoglycosides has not been fully explained. It is known that the drug attaches to a bacterial cell wall and is drawn into the cell via channels made up of the protein, porin. Once inside the cell, the aminoglycoside attaches to the cell's ribosomes. Ribosomes are the intracellular structures responsible for manufacturing proteins. This attachment either shuts down protein production or causes the cell to produce abnormal, ineffective proteins. The bacterial cell cannot survive with this impediment.

Antibiotic treatment using aminoglycosides may pair the drug with a second type of antibiotic, usually a beta-lactam or vancomycin, administered separately. Beta-lactams disrupt the integrity of the bacteria cell wall, making it more porous. The increased porosity allows more of the aminoglycoside into the bacteria cell.

Traditionally, aminoglycosides were administered at even doses given throughout the day. It was thought that a steady plasma concentration was necessary to combat infection. However, this administration schedule is time and labor intensive. Furthermore, administering a single daily dose can be as effective, or more effective, than several doses throughout the day.

Dosage depends on the patient's age, weight, gender, and general health. Since the drug is cleared by the kidneys, it is important to assess any underlying problems with kidney function. Kidney function is assessed by measuring the blood levels of creatinine, a protein normally found in the body. If these levels are high, it is an indication that the kidneys may not be functioning at an optimal rate and dosage will be lowered accordingly.