Rational use of aminoglycosides—Review and recommendations by the Swedish Reference Group for Antibiotics (SRGA)

Abstract

The Swedish Reference Group for Antibiotics (SRGA) has carried out a risk-benefit analysis of aminoglycoside treatment based on clinical efficacy, antibacterial spectrum, and synergistic effect with beta-lactam antibiotics, endotoxin release, toxicity, and side effects. In addition, SRGA has considered optimal dosage schedules and advice on serum concentration monitoring, with respect to variability in volume of drug distribution and renal clearance. SRGA recommends that aminoglycoside therapy should be considered in the following situations: (1) progressive severe sepsis and septic shock, in combination with broad-spectrum beta-lactam antibiotics, (2) sepsis without shock, in combination with broad-spectrum beta-lactam antibiotics if the infection is suspected to be caused by multi-resistant Gram-negative pathogens, (3) pyelonephritis, in combination with a beta-lactam or quinolone until culture and susceptibility results are obtained, or as monotherapy if a serious allergy to beta-lactam or quinolone antibiotics exists, (4) serious infections caused by multi-resistant Gram-negative bacteria when other alternatives are lacking, and (5) endocarditis caused by difficult-to-treat pathogens when monotherapy with beta-lactam antibiotics is not sufficient. Amikacin is generally more active against extended-spectrum beta-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli than other aminoglycosides, making it a better option in cases of suspected infection caused by multidrug-resistant Enterobacteriaceae. Based on their resistance data, local drug committees should decide on the choice of first-line aminoglycoside. Unfortunately, aminoglycoside use is rarely followed up with audiometry, and in Sweden we currently have no systematic surveillance of adverse events after aminoglycoside treatment. We recommend routine assessment of adverse effects, including hearing loss and impairment of renal function, if possible at the start and after treatment with aminoglycosides, and that these data should be included in hospital patient safety surveillance and national quality registries.

Antibiotic stability over six weeks in aqueous solution at body temperature with and without heat treatment that mimics the curing of bone cement

“…The LC-MS/MS method reveals that gentamicin was in part degraded by the initial heat treatment, while this 25% drop in concentration could not be detected by the less sensitive disk diffusion assay. Thus, tobramycin might be a more appropriate antibiotic to associate with PMMA, as it has an equivalent spectrum of activity 31 but improved stability in our experiment. Of course, tissue penetration is an additional factor in the performance of any antibiotic, be it locally or systemically applied, even if difficult to interpret.…”

Extended-Spectrum ß-Lactamase-Producing Enterobacteriaceae : Antibiotic consumption, Detection and Resistance Epidemiology

“…In 2013, the Swedish Reference Group of Antibiotics published recommendations for the rational use of aminoglycosides and emphasizes that use of amikacin in many situations is preferable to gentamicin/tobramycin. [238] Despite the very high susceptibility to tigecycline, it is a sparsely used drug for treatment mainly due to the limited urinary secretion and therefore not approved for treating UTIs, the most common site for infections caused by ESBL-producing E. coli. Serum concentrations of tigecycline are generally not adequate to treat bloodstream infections and increased mortality in patients with severe infections treated with tigecycline compared to other agents are reported.…”

The faecal flora: a source of healthcare-associated infections and antibiotic resistance

“…Aminoglycosides( e.g. gentamicin, tobramycin) have good antibacterial activity against Staphylococci spp, Enterobacteriaceae spp , Pseudomonas spp and Acinetobacter spp (91).…”