Advantages and disadvantages of aminoglycosides

Advantages

• Aminoglycosides are bactericidal and associated with rapid control of gram-negative infections.
• Most community- and healthcare-associated gram-negative pathogens are susceptible to aminoglycosides.
• Aminoglycosides have a ‘postantibiotic effect’ that allows for effective once-daily therapy.
• When combined with cell-wall–active drugs (eg beta lactams, glycopeptides), aminoglycosides are synergistic for enterococcal and streptococcal infections.
• Aminoglycosides rarely cause hypersensitivity reactions.
• Aminoglycosides are rarely associated with Clostridioides difficile (formerly known as Clostridium difficile) infection.

Disadvantages

• Aminoglycosides cause nephrotoxicity, usually associated with prolonged treatment courses (longer than 5 to 7 days) and pre-existing kidney impairment. Nephrotoxicity is generally reversible.
• Aminoglycosides cause vestibular and, less commonly, auditory toxicity, mostly associated with prolonged treatment courses. Vestibular and auditory toxicity are generally irreversible.