Aminoglycosides were the second major antibiotic class to be discovered from fermentation of microorganisms. They are structurally characterized by an aminocyclitol that is substituted in several different patterns by amino-and/or neutral sugar moieties. They are potent, bactericidal, water-soluble compounds that are given by parenteral administration. They are especially useful for treatment of infections caused by Gram-negative bacteria, including Pseudomonas aeruginosa. Limitations of the class include the development of microbial resistance by a variety of mechanisms and patient toxicity, especially nephrotoxicity and ototoxicity. Several semi-synthetic derivatives have been developed that have improved features, especially increased activity against resistant strains of bacteria. The newest aminoglycoside, plazomicin, is a semi-synthetic derivative of sisomicin that is undergoing further evaluation in clinical trials.