TREATMENT OF SEVERE INFECTIONS - IS AN AM INOGLYCOSIDE ALWAYS NECESSARY

Until recently, aminoglycoside antibiotics were the cornerstone for th e treatment of severe infections. The rationale for using combination therapy containing betalactams and aminoglycosides was not only to bro aden the antimicrobial spectrum but also to achieve enhanced bacterial killing by synergism and to prevent the emergence of antibiotic resis tance. However, with the advent of new potent broad-spectrum and highl y bactericidal antibiotics, the necessity of combining betalactams wit h aminoglycosides should be reassessed. This review questions the use of aminoglycosides in three severe infections frequently observed in i ntensive care units, nosocomial pneumonia, nosocomial sepsis and sever e diffuse peritonitis. A review of the literature suggests that the ad dition of an aminoglycoside to a broad-spectrum betalactam does not im prove the outcome in nosocomial pneumonia and severe diffuse peritonit is. However, the lack of large prospective studies in severe sepsis or septic shock makes it impossible to draw any conclusion about the add ition of an aminoglycoside, and the administration of these agents mus t be decided on an individual basis.