Aminoglycosides are any group of bactericidal antibiotics derived from species of streptomyces or micromonosporum bacteria that are effective against aerobic gram negative bacilli and Mycobacterium tuberculosis.
COMPOSITION OF AMINIGLYCOSIDES :
Amino modified sugars
ACTION : inhibits protein synthesis in bacteria
DOSAGE & ROUTE
Amikacin 15mg/kg q 8 hr IM,IV
Gentamicin 1mg/kg q 8 hr IM,IV
Streptomycin : in TBC (adults) 1g/day initially decreased to 1g 2-3 times weekly IM
Tobramycin 0.75-1.25 mg/kg q 6 hr
INDICATIONS OF AMINOGLYCOSIDES
Treatment of serious gram negative bacillary infections and infections caused by staphylococci.
In the management of active TBC in combination with other agents,eg.streptomycin
To decrease the no.of ammonia producing bacteria in the gut as part of the management of hepatic encephalopathy.
To treat some forms of infectious diarrhea,eg.kanamycin,neomycin.
Part of endocarditis prophylaxis,eg.gentamicin IM,IV .
CONTRAINDICATIONS : hypersensitivity to aminoglycosides or bisulfites
DRUG INTERACTION :
Inactivated by penicillins and cephalosporins when coadministered to pateints with renal insufficiency.
Increased incidence of ototoxicity with loop diuretics.
Increased incidence of nephrotoxicity with other nephrotoxic drugs.
SIDE EFFECTS : nausea,vomiting,urticaria,muscles weakness,rash etc.
ADVERSE EFFECTS: vertigo,myocarditis,hemolytic anemia,thrombocytopenia,pancytopenia, leukemia,hepatic necrosis,muscle paralysis,anaphylaxis,serum sickness etc.
TOXICITY : ototoxicity,nephrotoxicity
ROLE OF NURSE
For infection at starting and throughout the therapy.
Deafness should be noticed by audiometric,roaring and ringing in ears.
Vertigo should be assessed before,during and after treatment.
Monitor intake and output.
Daily weight should be taken to assess hydration status and renal function.
Assess patient for signs of superinfection.
Monitor neurologic status.
Keep patient hydrated 1500-2000ml/day during therapy.
IM administrstion should be deep into well developed muscles.Alternate injection site.
Y-site compatibility and incompatability should be considered.
In case if there is vestibular dysfunction,nausea,vomiting,headache,fever then drug should be discontinued.
PATIENT/FAMILY TEACHING :
Instruct patient to report if there is loss of hearing, feeling of fullness in head.
To report headache, dizziness,renal impairment.
Therapeutic response if there is absence of fever,draining wounds .etc