aminoglycoside Flashcards
Question 1: What are some examples of aminoglycosides?
Answer 1: Aminoglycosides include amikacin, gentamicin, neomycin sulfate, streptomycin, and tobramycin.
Question 2: What is the primary mode of administration for aminoglycosides for systemic infections?
Answer 2: Aminoglycosides are not absorbed from the gut and must be given by injection for systemic infections.
Question 3: Which aminoglycoside is the preferred choice in the UK for the treatment of serious infections?
Answer 3: Gentamicin is the aminoglycoside of choice in the UK for the treatment of serious infections.
Question 4: What is the spectrum of activity of gentamicin, and what are its common combination therapies in undiagnosed serious infections?
Answer 4: Gentamicin has a broad spectrum but is inactive against anaerobes and has poor activity against haemolytic streptococci and pneumococci. In undiagnosed serious infections, it is usually given in conjunction with a penicillin or metronidazole (or both).
Question 5: What is the preferred treatment duration when using aminoglycosides?
Answer 5: Whenever possible, treatment with aminoglycosides should not exceed 7 days.
Question 6: In what situations might high doses of aminoglycosides be indicated?
Answer 6: High doses of aminoglycosides may be indicated for serious infections, especially in the neonate, in patients with cystic fibrosis, or in immunocompromised patients.
Question 7: What is the primary use of amikacin, and why is it preferred in certain cases?
Answer 7: Amikacin is used in the treatment of serious infections caused by gentamicin-resistant Gram-negative bacilli, as it is more stable than gentamicin to enzyme inactivation.
Question 8: What is the primary use of tobramycin, and how is it administered for specific conditions?
Answer 8: Tobramycin is used for the treatment of chronic pulmonary Pseudomonas aeruginosa infection in cystic fibrosis. It can be administered by nebulizer or inhalation of powder on a cyclical basis.
Question 9: What are the primary uses of neomycin sulfate, and what precautions are needed in its use?
Answer 9: Neomycin sulfate is used for infections of the skin or mucous membranes and to reduce the bacterial population of the colon before bowel surgery or in hepatic failure. It is too toxic for parenteral administration. Oral administration may lead to malabsorption, and absorption may occur in hepatic failure patients, leading to potential toxicity.
User
make for this aswell: streptomycin is active against Mycobacterium tuberculosis and is now almost entirely reserved for tuberculosis.
Question: What is the primary use of streptomycin, and what condition is it almost entirely reserved for?
Answer: Streptomycin is primarily used for the treatment of Mycobacterium tuberculosis infections and is now almost almost entirely reserved for tuberculosis.
Question 1: What are some examples of aminoglycosides?
Answer 1: Aminoglycosides include amikacin, gentamicin, neomycin sulfate, streptomycin, and tobramycin.
Question 2: What is the primary mode of administration for aminoglycosides for systemic infections?
Answer 2: Aminoglycosides are not absorbed from the gut and must be given by injection for systemic infections.
Question 3: Which aminoglycoside is the preferred choice in the UK for the treatment of serious infections?
Answer 3: Gentamicin is the aminoglycoside of choice in the UK for the treatment of serious infections.
Question 4: What is the spectrum of activity of gentamicin, and what are its common combination therapies in undiagnosed serious infections?
Answer 4: Gentamicin has a broad spectrum but is inactive against anaerobes and has poor activity against haemolytic streptococci and pneumococci. In undiagnosed serious infections, it is usually given in conjunction with a penicillin or metronidazole (or both).
Question 5: What is the preferred treatment duration when using aminoglycosides?
Answer 5: Whenever possible, treatment with aminoglycosides should not exceed 7 days.
Question 6: In what situations might high doses of aminoglycosides be indicated?
Answer 6: High doses of aminoglycosides may be indicated for serious infections, especially in the neonate, in patients with cystic fibrosis, or in immunocompromised patients.
Question 7: What is the primary use of amikacin, and why is it preferred in certain cases?
Answer 7: Amikacin is used in the treatment of serious infections caused by gentamicin-resistant Gram-negative bacilli, as it is more stable than gentamicin to enzyme inactivation.
Question 8: What is the primary use of tobramycin, and how is it administered for specific conditions?
Answer 8: Tobramycin is used for the treatment of chronic pulmonary Pseudomonas aeruginosa infection in cystic fibrosis. It can be administered by nebulizer or inhalation of powder on a cyclical basis.
Question 9: What are the primary uses of neomycin sulfate, and what precautions are needed in its use?
Answer 9: Neomycin sulfate is used for infections of the skin or mucous membranes and to reduce the bacterial population of the colon before bowel surgery or in hepatic failure. It is too toxic for parenteral administration. Oral administration may lead to malabsorption, and absorption may occur in hepatic failure patients, leading to potential toxicity.
User
make for this aswell: streptomycin is active against Mycobacterium tuberculosis and is now almost entirely reserved for tuberculosis.
Question: What is the primary use of streptomycin, and what condition is it almost entirely reserved for?
Answer: Streptomycin is primarily used for the treatment of Mycobacterium tuberculosis infections and is now almost almost entirely reserved for tuberculosis.
Question: Why is once-daily administration of aminoglycosides preferred in many cases, and in which specific conditions should it be avoided?
Answer: Once-daily administration of aminoglycosides is preferred for its convenience and adequate serum concentrations. It should be avoided in patients with endocarditis due to Gram-positive bacteria, HACEK endocarditis, burns of more than 20% of the total body surface area, or creatinine clearance less than 20 mL/minute. It is not recommended in pregnancy due to insufficient evidence.
Question: Why is serum concentration monitoring important for patients receiving aminoglycosides, and in which specific cases should it be performed?
Answer: Serum concentration monitoring is crucial to prevent toxicity and ensure efficacy of aminoglycosides. It should be performed in patients receiving parenteral aminoglycosides, the elderly, individuals with obesity, those with cystic fibrosis, high-dose regimens, and in cases of renal impairment.
Question: What is the MHRA/CHM advice regarding the use of aminoglycosides, and why is it important for healthcare professionals and patients to be aware of it?
Answer: The MHRA/CHM advises that aminoglycosides, such as gentamicin, amikacin, tobramycin, and neomycin, are associated with an increased risk of deafness, particularly in patients with mitochondrial mutations, including the m.1555A>G mutation. Although these mutations are rare, healthcare professionals should weigh the need for aminoglycoside treatment against alternative options in patients with susceptible mutations. Genetic testing may be considered, especially for those requiring recurrent or long-term aminoglycoside treatment. However, urgent treatment should not be delayed. To minimize risks, continuous monitoring of renal and auditory function, hepatic function, and laboratory parameters is recommended for all patients. Patients with known mitochondrial mutations or a family history of **ototoxicity **should inform their healthcare provider before using an aminoglycoside.
Contra-indicationsFor all aminoglycosides (by injection)
Myasthenia gravis (aminoglycosides may impair neuromuscular transmission)
Side-effects
Ototoxicity and nephrotoxicity are important side-effects to consider with aminoglycoside therapy. Nephrotoxicity occurs most commonly in patients with renal impairment, who may require reduced doses; monitoring is particularly important in the elderly.
Pregnancy
There is a risk of auditory or vestibular nerve damage in the i**nfant **when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin. The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential.
Monitoring in pregnancy
If given during pregnancy, serum-aminoglycoside concentration monitoring is essential.
Question: Why is serum concentration monitoring important for aminoglycosides, and what are the key considerations for monitoring serum concentrations in patients receiving these antibiotics?
Answer: Serum concentration monitoring is crucial for aminoglycosides to prevent both excessive and subtherapeutic concentrations, ensuring both efficacy and safety. Serum-aminoglycoside concentrations should be measured in all patients receiving parenteral aminoglycosides, particularly in cases of obesity, high doses, cystic fibrosis, and in the elderly. For patients with normal renal function, concentrations should be measured after 3 or 4 doses of a multiple daily dose regimen and after a dose change. Multiple daily dose regimens require blood samples to be taken around 1 hour after administration (‘peak’ concentration) and just before the** next dose** (‘**trough’ **concentration). If the trough concentration is high, the dosing interval must be increased, while a high peak concentration indicates the need for a decreased dose. In the case of once daily dose regimens, local guidelines should be consulted for serum concentration monitoring. In addition to serum monitoring, renal function should be assessed before and during aminoglycoside treatment, and auditory and vestibular function should also be monitored throughout the course of treatment.
