What are examples of aminoglycosides?

Aminoglycoside Antibiotics: Examples and Classification

Core Aminoglycoside Agents

The primary aminoglycosides used in clinical practice include gentamicin, tobramycin, amikacin, streptomycin, kanamycin, and neomycin. 1, 2

Most Commonly Used Agents

• Gentamicin is the most frequently prescribed aminoglycoside in clinical practice, particularly in neonatal units and for serious gram-negative infections 3, 2
• Tobramycin is commonly used alongside gentamicin and amikacin for parenteral therapy of severe infections 4
• Amikacin may be particularly effective against resistant organisms when other aminoglycosides fail 5, 6

Additional Aminoglycosides

• Streptomycin has a distinct core ring structure that differs from all other aminoglycosides, explaining why cross-resistance between streptomycin and other aminoglycosides is uncommon 6
• Kanamycin is used in specific clinical scenarios, particularly for drug-resistant tuberculosis 6
• Neomycin is primarily used for bowel preparation rather than systemic infections 6

Structural and Pharmacologic Distinctions

Streptomycin stands apart structurally from other aminoglycosides, which has important resistance implications. 6

• All E. faecium are intrinsically resistant to amikacin, kanamycin, netilmicin, and tobramycin 6
• E. faecalis are often resistant to kanamycin and amikacin 6
• Strains resistant to gentamicin may remain susceptible to streptomycin due to different resistance mechanisms 6

Clinical Context for Selection

For Plague Treatment

• Streptomycin and gentamicin are both FDA-approved aminoglycosides for plague, with similar efficacy profiles 6

For Endocarditis

• Gentamicin at 3 mg/kg per 24 hours IV/IM in 3 equally divided doses is standard for enterococcal endocarditis in combination with cell wall-active agents 6
• Streptomycin at 15 mg/kg per 24 hours IV/IM in 2 equally divided doses is an alternative when gentamicin resistance is present 6

For Drug-Resistant Tuberculosis

• Amikacin, kanamycin, streptomycin, and capreomycin (a cyclic polypeptide, not technically an aminoglycoside but grouped with "injectables") are used 6

For Urologic Procedures

• Gentamicin 5 mg/kg IV single dose, tobramycin 5 mg/kg IV single dose, or amikacin 15 mg/kg IV single dose are options for prophylaxis 6

For Sepsis and Septic Shock

• Gentamicin equivalent at 5-7 mg/kg daily is recommended for once-daily dosing in patients with preserved renal function 6

Critical Prescribing Considerations

All aminoglycosides share three key characteristics: concentration-dependent killing, a post-antibiotic effect, and synergism with other antibacterial drugs. 6

• Aminoglycosides are polar drugs with poor gastrointestinal absorption, requiring intravenous or intramuscular administration 2
• They are excreted renally and require dose adjustment in renal impairment 3
• Single daily dosing is now preferred over traditional multiple daily dosing for most indications due to equal or better efficacy and reduced toxicity risk 1, 5