Aminoglycoside contraindications and precautions
Aminoglycoside precautions and contraindications for use are listed in Aminoglycoside contraindications and precautions.
Contraindications
Do not use aminoglycosides in patients with:
- a history of aminoglycoside-induced vestibular or auditory toxicity
- a history of a severe hypersensitivity reaction to an aminoglycoside (these reactions are rare) [NB1].
Precautions
Aminoglycosides should generally not be used in patients:
- with pre-existing significant auditory impairment
- with a pre-existing vestibular condition
- who have a first-degree relative with aminoglycoside-induced auditory toxicity, since some people have a rare inherited genetic predisposition [NB2]
- who have a condition or who are taking drugs that can interfere with neuromuscular transmission [NB3].
A single dose of an aminoglycoside can be used in patients [NB4]:
- with chronically impaired kidney function (adults with a creatinine clearance less than 60 mL/minute) [NB5] [NB6]
- with rapidly deteriorating kidney function thought to be reversible
- who are frail and elderly (eg 80 years or olderJohnston, 2014).
NB1: Severe hypersensitivity reactions include anaphylaxis, compromised airway, angioedema, hypotension, collapse, severe cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome / toxic epidermal necrolysis [SJS/TEN]), and significant internal organ involvement (eg acute interstitial nephritis).
NB2: Ask about a family history of hearing loss before administering aminoglycosides. Aminoglycoside-induced ototoxicity has a genetic susceptibility in some individuals. Mitochondrial mutations have been identified as genetic factors underlying hearing loss in cases of aminoglycoside-induced ototoxicity. These mutations are also associated with a predisposition to isolated hearing loss. Where possible, genetic testing for these mutations should be considered in patients with a family history of aminoglycoside-induced ototoxicity or those likely to require prolonged therapy with an aminoglycosideJing, 2015McDermott, Mahaveer, , 2022McDermott, Wolf, , 2022Nguyen, 2019.
NB3: In patients with myasthenia gravis, seek expert advice from a neurologist before using an aminoglycoside.
NB4: Multiple doses of an aminoglycoside should not be used in these patients unless recommended by an expert.
NB5: In patients with a creatinine clearance less than 20 mL/min, an aminoglycoside may be used if the benefits outweigh the risk (see Aminoglycoside use in patients with kidney impairment).
NB6: Do not avoid aminoglycosides in patients with minimal residual kidney function receiving long-term dialysis.