Antimicrobial agents--Part II. The aminoglycosides: streptomycin, kanamycin, gentamicin, tobramycin, amikacin, neomycin.

Aminoglycoside antibiotics are poorly absorbed from the gastrointestinal tract, do not penetrate well into the cerebrospinal fluid, are minimally bound to plasma proteins, and are rapidly excreted by the normal kidney. Neomycin is limited by its toxicity to irrigating and topical preparations or to oral medication for surgical bowel preparations or hepatic coma. Streptomycin has only a few specific indications, because newer agents are available that have broader spectrums of activity. Kanamycin is indicated in serious gram-negative infections in which Pseudomonas aeruginosa is not a likely causative agent. Gentamicin, tobramycin, and amikacin are effective against a broad spectrum of gram-negative organisms including P. aeruginosa. In general, both gentamicin and tobramycin are more active in vitro than amikacin on a weight basis; however, higher serum levels are achievable with amikacin than with the two others. Amikacin is probably the aminoglycoside of first choice when gentamicin resistance is strongly suspected.