Considerations when prescribing aminoglycosides

The benefit–harm profile of aminoglycoside therapy depends on both the infection for which it is used (eg severity of infection, likelihood of the pathogen being resistant to other antibiotics) and patient factors (eg risk factors for adverse effects). When aminoglycoside therapy is recommended in these guidelines, it is the consensus view of the Antibiotic Expert Group that the potential benefits of aminoglycoside therapy outweigh potential harms.

Aminoglycoside toxicity has led some clinicians to argue that less toxic antibiotics (eg carbapenems, broad-spectrum cephalosporins) should be used instead; these are generally more broad-spectrum. Given the rapid emergence of resistance to other classes of antibiotics, and the increased incidence of Clostridioides difficile (formerly known as Clostridium difficile) infection, concerns about toxicity must be balanced against the known advantages of aminoglycosides (advantages and disadvantages of aminoglycoside use are listed in Advantages and disadvantages of aminoglycosides). While aminoglycosides should be used cautiously in some patient groups, there are few contraindications to use. Aminoglycoside precautions and contraindications for use are listed in Aminoglycoside contraindications and precautions. Checklist for prescribing aminoglycosides contains a checklist of factors to consider when prescribing aminoglycosides.