Pre-existing medical conditions—such as kidney disease, eighth cranial nerve disease, myasthenia gravis, and Parkinson's disease—should be discussed prior to taking any aminoglycosides. Pregnant women are usually advised against taking aminoglycosides, because their infants may suffer damage to their hearing, kidneys, or sense of balance. However, those factors need to be considered alongside the threat to the mother's health and life in cases of serious infection. Aminoglycosides do not pass into breast milk to any great extent, so nursing mothers may be prescribed aminoglycosides without injuring their infants.
Streptomycin, the first aminoglycoside, was isolated from Streptomyces griseus in the mid-1940s. This antibiotic was very effective against tuberculosis. One of the main drawbacks to streptomycin is its toxicity, especially to cells in the inner and middle ear and the kidney. Furthermore, some strains of tuberculosis are resistant to treatment with streptomycin. Therefore, medical researchers have put considerable effort into identifying other antibiotics with streptomycin's efficacy, but without its toxicity.
Aminoglycosides are absorbed very poorly from the gastrointestinal tract; in fact, aminoglycosides taken orally are excreted virtually unchanged and undiminished in quantity. The route of drug administration depends on the type and location of the infection being treated. The typical routes of administration are by intramuscular (injection into a muscle) or intravenous injection (injection into a vein), irrigation, topical skin application, or inhalation. If the infection being treated involves the central nervous system, the drug can be injected into the spinal canal.
The bactericidal ability of aminoglycosides has not been fully explained. It is known that the drug attaches to a bacterial cell wall and is drawn into the cell via channels made up of the protein, porin. Once inside the cell, the aminoglycoside attaches to the cell's ribosomes. Ribosomes are the intracellular structures responsible for manufacturing proteins. This attachment either shuts down protein production or causes the cell to produce abnormal, ineffective proteins. The bacterial cell cannot survive with this impediment.
Antibiotic treatment using aminoglycosides may pair the drug with a second type of antibiotic, usually a beta-lactam or vancomycin, administered separately. Beta-lactams disrupt the integrity of the bacteria cell wall, making it more porous. The increased porosity allows more of the aminoglycoside into the bacteria cell.
Traditionally, aminoglycosides were administered at even doses given throughout the day. It was thought that a steady plasma concentration was necessary to combat infection. However, this administration schedule is time and labor intensive. Furthermore, administering a single daily dose can be as effective, or more effective, than several doses throughout the day.
Dosage depends on the patient's age, weight, gender, and general health. Since the drug is cleared by the kidneys, it is important to assess any underlying problems with kidney function. Kidney function is assessed by measuring the blood levels of creatinine, a protein normally found in the body. If these levels are high, it is an indication that the kidneys may not be functioning at an optimal rate and dosage will be lowered accordingly.
Julia Barrett, The Gale Group Inc., Gale, Detroit,