Should aminoglycoside antibiotics be abandoned?

BACKGROUND: Aminoglycosides can cause nephrotoxicity and ototoxicity. Alter natives are available. METHODS: Surgical service antibiotic use, aminoglycoside toxicity, and peri operative culture/sensitivity results from July 1998 to June 1999 were revi ewed. RESULTS: Of 289 positive cultures in 243 patients, 92 cultures (32%) grew 1 51 Gram-negative rods (GNRs). Aminoglycosides were used in 26 patients and 4 of 26 (15%) suffered nephrotoxicity. Of the 112 GNRs tested against cefta zidime, 111 (99%) were sensitive to it which was significantly better than amikacin (56 of 61, 92%, P = 0.038), gentamicin (116 of 134, 87%, P <0.001) , and tobramycin (67 of 81, 83%, P <0.001). The proportion sensitive to cef uroxime (26 of 30, 87%) was equivalent to the proportions sensitive to gent amicin (87%, P = NS) and tobramycin (83%, P = NS). Of the 35 GNRs that were resistant to gentamicin and/or tobramycin, 15 (43%) were Pseudomonas aerug inosa. CONCLUSIONS: Aminoglycosides produce a significant rate of nephrotoxicity. There are antibiotics with equal or better sensitivity profiles than aminog lycosides against GNRs and Pseudomonas. Aminoglycoside use is rarely, if ev er, indicated. (C) 2001 by Excerpta Medica, Inc.