Aminoglycosides: Uses, common brands, and safety info

If you contract a serious infection while in the hospital—whether in your lungs, urinary tract, or bloodstream—there is a chance your recovery may depend on a drug class that is more than 70 years old. Aminoglycoside antibiotics were discovered in 1943, not long after the groundbreaking discovery and initial uses of penicillin. Over the years, the aminoglycosides have gradually had less frequent use, but they have still retained an important clinical use in the direst of situations in hospitals, as well as for a few outpatient infections. The reason for their powerful potential but limited use is the potential for adverse effects. Here, we will review aminoglycoside uses, side effects, and costs. First, use the table below to find examples of aminoglycosides.

Other aminoglycosides

• Kanamycin

What are aminoglycosides?

Aminoglycosides are antibiotics that have the potential to kill a variety of different bacteria. The two main categories of bacteria are gram-positive and gram-negative, based on their color under a microscope after a stain is applied to them. Aminoglycosides can be effective for both. They are predominantly used in combination with other antibiotics to fight serious infections with gram-negative bacteria, like Pseudomonas aeruginosa infections (pneumonia), and gram-positive bacteria, like enterococcus (including UTIs). Beyond the two main categories of bacteria, certain members of this antibiotic type can help eliminate atypical forms of bacteria, such as the mycobacteria that cause tuberculosis. Other members of the aminoglycoside family can be used to treat parasitic infections.

The medical utility of aminoglycosides varies from agent to agent. Some aminoglycosides work better than others for particular infections and in particular bodily locations. Some are useful by themselves and others are typically given as part of a combination of antibiotics.

How do aminoglycosides work?

One commonality of the aminoglycoside class is its mechanism of action. They bind to RNA within the bacterial cell’s ribosome, making the germ unable to produce normal proteins. Ineffective protein synthesis kills the bacteria. Therefore, aminoglycosides have bactericidal activity since they are capable of killing bacteria rather than merely inhibiting bacteria. Aminoglycosides also produce a prolonged postantibiotic effect, meaning that bacterial regrowth is suppressed for a period of time even after the antibiotic is discontinued.

Particularly in gram-positive bacterial infections, aminoglycosides work synergistically with other antibacterial drugs, such as vancomycin, to provide better treatment. In this example of aminoglycoside synergy, vancomycin allows the aminoglycoside to pass through the bacterial cell wall and enter the bacteria easier. 

By comparison, in the setting of a serious gram-negative bacterial infection, adding an aminoglycoside to the antibiotic regimen may be advisable to ensure that the bacteria is not resistant to at least one of the chosen antibiotics.

RELATED: Learn more about antibiotic resistance

What are aminoglycosides used for?

Aminoglycoside antibiotics may be used to treat the following infections and infectious diseases:

• Sepsis

• Bacteremia (bloodstream infection)

• Urinary tract infection

• Respiratory tract infection acquired within a hospital (pneumonia)

• Cystic fibrosis

• Osteomyelitis (bone infection)

• Infections within the abdominal or pelvic cavity

• Endocarditis (heart valve infection)

• Meningitis (brain and spinal cord membrane infection)

• Hepatic encephalopathy (confusion related to liver failure)

• Tuberculosis

• Otitis externa 

• Conjunctivitis

• Parasitic amebic infections of the intestinal tract

• Plague

• Tularemia

Who can take aminoglycosides?

Men, women, seniors, and children can all take aminoglycosides if the benefits outweigh the risks. For example, a hospitalized individual who is gravely ill with a kidney infection complicated by sepsis can benefit greatly from powerful antibiotic treatment, possibly making it worthwhile even if it has side effect risks. 

For example, a child with swimmer’s ear may benefit from treatment with aminoglycoside ear drops that have fewer side effects due to the topical form rather than oral or intravenous. However, a senior with a serious infection may be best treated with an alternative antibiotic due to the greater susceptibility of side effects with advanced age.

Are aminoglycosides safe?

Aminoglycosides carry the FDA’s strongest warning regarding nervous system, kidney, and ear complications, as well as the potential for blockade of the nerve to muscle signaling system. The chance of these toxicities requires the utmost caution when deciding on treatment, meticulous dosing when initiating aminoglycoside therapy, and rigorous monitoring during the course. The monitoring may involve kidney blood tests, hearing tests, and medication levels.

Recalls

•  Neomycin (2019)

Restrictions

Healthcare providers should use aminoglycosides with caution in the following cases:

• No one who has had a hypersensitivity reaction to an aminoglycoside should take it again. 

• Particular caution before treatment with an aminoglycoside is advised for anyone with a history of kidney, ear, nervous system, or neuromuscular problems, as well as for seniors and newborns. 

• The concurrent presence of dehydration or electrolyte disturbances should also prompt additional caution.

Can you take aminoglycosides while pregnant or breastfeeding?

Aminoglycosides have been associated with harm to the fetus, so they are usually avoided unless the potential benefit outweighs the risk. The use of aminoglycosides while breastfeeding is more common but must still take into account the possibility of risk and benefit.

Are aminoglycosides controlled substances?

The DEA does not classify aminoglycosides as controlled substances.

Common aminoglycosides side effects

Daily dosing of aminoglycosides can reduce the incidence of kidney toxicity but there is still a risk of the following side effects:

• Ototoxicity (ear damage)—hearing loss, dizziness, vertigo, tinnitus

• Nephrotoxicity (kidney damage)—elevation of renal function tests

• Neurotoxicity (nervous system damage)

• Neuromuscular blockade (severe weakness)

• Seizures

• Elevated spinal fluid pressure

• Nausea, vomiting, or diarrhea

• Severe allergic reactions

How much do aminoglycosides cost?

Despite their long-standing presence in the medical world, aminoglycosides can still carry a hefty price tag. Nebulized tobramycin can cost more than $7,000 for a one-month supply. A SingleCare discount card can help you to save money on medication expenses.