[3S] Aminoglycosides & Spectinomycin Flashcards
Aminoglycosides Excretion
Urine, with small portions of oral administrations excreted through feces
PKINETICS
● Limited tissue penetration (esp. BBB/eyes)
● Poorly absorbed orally
● Excretion is directly proportional to creatine clearance
All aminoglycosides
Gentamicin ROA
IV, IM, Topical, Ocular, Intrathecal
MOA
● Bactericidal (irreversible)
● Passive via porins
● Active via oxygen-dependent process
● Bind to 30S:
o Blocks initiation complex
o Misread mRNA
o Inhibit mRNA translocation
All aminoglycosides & spectinomycin
CLINICAL APPLICATIONS
● Gr(+) bacteria
● Gr(-) bacteria
o E. coli, Klebsiella, Providencia, Serratia, Enterobacter, Proteus, Pseudomonas
● Staphylococci
● E. faecialis
Gentamicin & Tobramycin
CLINICAL APPLICATIONS
More active against Serratia
Gentamicin
Enhances the uptake of Gentamicin
Penicillin or Vancomycin
CLINICAL APPLICATIONS
NO ACTIVITY against anaerobes
ALL except Plazo, Strepto, Specti
TOXICITIES
● Nephrotoxicity
● Ototoxicity:
o Vestibular dysfunction
o Hearing loss
Gentamicin
Tobramycin ROA
IV, IM, IH
CLINICAL APPLICATIONS
More active against P. aeruginosa
Tobramycin
CLINICAL APPLICATIONS
● Lower RTIs
● Cystic fibrosis
● Superficial eye infections (ointments and drops)
Tobramycin
CLINICAL APPLICATIONS
NO ACTIVITY against anaerobes AND E. faecium
Tobramycin
TOXICITIES
● Ototoxic (rare)
● Nephrotoxic (rare)
● Neuromuscular blockade
Tobramycin
Amikacin ROA
IV
CLINICAL APPLICATIONS
● Gr(-) bacteria
o Proteus, Pseudomonas, Enterobacter, Serratia
● Resistant to tobramycin/gentamicin-inactivating enzymes
Amikacin
CLINICAL APPLICATIONS
MDR and streptomycin-resistant TB
Amikacin
TOXICITIES
● Ototoxicity (Auditory damage)
● Nephrotoxicity
● Neuromuscular blockade
Amikacin
Netilmicin ROA
IV, IM, Topical, Ocular, Intrathecal, PO
CLINICAL APPLICATIONS
● Gentamicin-resistant bacteria
● Tobramicin-resistant bacteria
Netilmicin
Can be interchangeable with gentamicin and tobramycin
Netilmicin
TOXICITIES
● Ototoxicity and nephrotoxicity
● Neuromuscular blockade
Netilmicin & Paromomycin
Neomycin ROA
PO, Topical
CLINICAL APPLICATIONS
● Gr(+) bacteria
● Gr(-) bacteria
● Some mycobacteria
Neomycin
CLINICAL APPLICATIONS
● Infected skin lesions
● Elective bowel surgery
● Hepatic encelopathy
Neomycin
TOXICITIES
● Ototoxicity (Auditory damage)
● Nephrotoxicity
● Neuromuscular blockade
● Irritation
Neomycin
CLINICAL APPLICATIONS
NO ACTIVITY against P. aeruginosa, Streptococci + anaerobes
Neomycin, Kanamycin, Paromomycin
TOXICITIES
Allergic reactions (contact dermatitis)
Neomycin
Kanamycin ROA
PO, Topical, IV, IM
CLINICAL APPLICATIONS
MDR-TB (but amikacin is preferred)
Kanamycin
TOXICITIES
● Ototoxicity (auditory damage)
● Nephrotoxicity
● Neuromuscular blockade
● [For MDR-TB] Cross-resistance with amikacin
Kanamycin
Paromomycin ROA
PO, Topical, IV, IM
CLINICAL APPLICATIONS
● Visceral leishmaniasis
● Cutaneous leishmaniasis
● E. histolytica infections
Paromomycin
Plazomicin ROA
IV
CLINICAL APPLICATIONS
Gr(-) bacilli
● Enterobacteriaceae
● Staphylococci
● cUTIs
Plazomicin
TOXICITIES
● Possibly causes renal-related adverse effects
● Neuromuscular blockade
Plazomicin
Streptomyces griseus
Streptomycin
Streptomycin ROA
IM/IV
CLINICAL APPLICATIONS
● MTB
● Viridans streptococci
Streptomycin
CLINICAL APPLICATIONS
● Extracellular tubercle bacilli (second-line TB)
● TB (second-line) Plague Tularemia Brucellosis
Streptomycin
CLINICAL APPLICATIONS:
Penicillin:
o Enterococcal endocarditis
o Viridans
o Streptococcal endocarditis
Streptomycin
TOXICITIES
● Ototoxicity (vestibulotoxic)
● Nephrotoxicity
● Hypersensitivity
● Neuromuscular blockade
Streptomycin
Spectinomycin ROA
IM
CLINICAL APPLICATIONS
● Drug-resistant gonorrhea
● Penicillin-allergic gonorrhea
Spectinomycin
CLINICAL APPLICATIONS
NOT RECOMMENDED for pharyngeal gonococcal infections
Spectinomycin
TOXICITIES
● Pain at injection site
● Fever
● Nausea
Spectinomycin
