What Is Aminoglycoside Toxicity?

Aminoglycoside antibiotics are named because their molecular structure has an aminocycloalcohol and one or more amino sugar molecules, which are connected by glycoside bonds to form glycosides. Most of them are polar compounds and are easily soluble in water. Not easy to absorb, generally need injection. Aminoglycoside antibiotics have the function of binding to bacterial ribosomes and interfering with the bacterial protein synthesis process. They are a class of bactericidal bactericides and are currently important drugs for the treatment of severe aerobic gram-negative bacteria.

Basic Information

Chinese name

Aminoglycoside antibiotics

Nature

Glycoside antibiotics

Pharmacological action

Concentration-dependent

Belong to

Bactericidal

Pharmacological effects of aminoglycoside antibiotics

All members of aminoglycosides can act on ribosomes in bacteria, inhibit protein synthesis, and destroy the integrity of bacterial cell membranes. It has strong antibacterial activity against various aerobic Gram-negative bacteria including Escherichia coli, Pseudomonas aeruginosa, Proteus, Klebsiella, Enterobacter, Shiga, Citrobacter; It also has certain antibacterial effects on Serratia, Salmonella, Alcaligenes, Acinetobacter and Haemophilus; it has weak effects on Streptococcus of each group, and is resistant to Enterococcus and anaerobic bacteria. Streptomycin has a role in killing Mycobacterium tuberculosis.

Application of aminoglycoside antibiotics

Mainly used for systemic infections caused by sensitive aerobic gram-negative bacilli. Especially for common Gram-negative bacteria such as Pseudomonas aeruginosa, Klebsiella, and Escherichia coli, it has a long-term post-antibacterial effect (PAE), so it is used as a treatment for aerobic Gram-negative Infections, such as meningitis, respiratory infections, urinary tract infections, skin and soft tissue infections, gastrointestinal infections, burn infections, and bone and joint infections. For severe infections caused by Gram-negative bacilli such as sepsis, pneumonia, and meningitis, the use of aminoglycosides alone may fail. At this time, other antibacterial drugs with strong antibacterial activity against Gram-negative bacteria, such as broad-spectrum Synthesis of penicillin, third-generation cephalosporins, and fluoroquinolones.

Aminoglycoside adverse reactions

The main adverse reactions of aminoglycosides are nephrotoxicity and ototoxicity, especially in children and the elderly.

Ototoxicity

Includes vestibular dysfunction and cochlear auditory nerve damage. Vestibular dysfunction is mainly manifested as dizziness, vision loss, nystagmus, dizziness, nausea, vomiting, and ataxia, mainly vertigo; cochlear auditory nerve damage mainly manifests as tinnitus, hearing loss, and permanent deafness. Vestibular dysfunction is more common in neomycin, kanamycin, streptomycin, and gentamicin; cochlear auditory nerve damage is more common in neomycin, kanamycin, and amikacin; other varieties can also cause ototoxicity. Pregnant women should be contraindicated because this class of drugs may cause hearing loss in newborns during pregnancy.

2. Renal toxicity

Aminoglycosides are a common cause of drug-induced renal failure, usually manifested as proteinuria, cast urine, hematuria, etc. In severe cases, azotemia can occur and lead to decreased renal function. Renal hypofunction can increase the plasma concentration of aminoglycosides, and further aggravate renal dysfunction and ototoxicity.

3. Neuromuscular palsy

Can cause myocardial depression, decreased blood pressure, limb paralysis and respiratory failure. Neostigmine and calcium can be used to counter treatment.

4. Allergies

Rash, fever, angioedema.

Aminoglycoside antibiotics precautions

Those who are allergic to this class of drugs are prohibited. Patients with myasthenia gravis or Parkinson's disease should try to avoid using this class of drugs. The toxicity of this class of drugs is related to the dosage and time course of the drug. It also varies from drug to drug. Even after stopping the drug, irreversible toxicity can occur. Discontinue treatment as soon as early signs of dysfunction are found. Aminoglycosides cannot be used in combination with other neuromuscular blockers. They can aggravate neuromuscular blockade and cause symptoms such as muscle weakness and respiratory depression. Urine routine and renal function tests should be performed regularly before and during the medication to prevent serious renal toxicity. When combined with capreomycin, cisplatin, itanilic acid, furosemide, or vancomycin (or norvancomycin), it may increase ototoxicity and renal toxicity. Combined with polymyxin, it can increase nephrotoxicity and neuromuscular blockade. Aminoglycosides can cause mutual inactivation when mixed with -lactams (cephalosporins and penicillins).

(Note: The above content is only for introduction, the drug use must be carried out by a regular hospital under the guidance of a doctor.)