Safer and less toxic agents are available to treat the majority of gram-positive
infections. Since the patient is experiencing a life-threatening infection, pre-
scribers combine animoglycosides with penicillin, cephalosporins, or ancomycin
to give a one-two punch knockout to the bacteria.
There are significant side effects to using aminogylcosides. These are nephro-
toxicity, neurotoxicity, hyersensitivity, and ototoxicity (problems with hearing
and balance).
Assess the patient according to the guidelines for all antibiotics as described
previously in this chapter for penicillin. Infants with botulism and patients with
myasthenia gravis or Parkinsonism will experience more muscle weakness than
other patients who are treated with animoglycosides. You must also assess if the
patient has hearing or kidney problems or allergies.
Before administering aminoglycosides, obtain a baseline assessment for the
patient including audiogram, renal function, and vestibular function studies.
When administering aminoglycosides intravenously, dilute the medication in
solution as per the package insert and infuse it over a 30- to 60-minute period.
Use a smaller than normal dose for elderly patients who are at greater risk for
kidney toxicity and ototoxicity.
If aminoglycides are given IM, then give the injection deep into the upper
outer quadrant of the gluteal muscle.
After administering aminoglycides, keep the patient well hydrated and mon-
itor the patient’s intake and output to determine if there is nephrotoxicity. Monitor
the patient’s temperature, cultures, and WBC to determine if the infection is
resolving. A daily urinalysis should be obtained for signs of kidney irritation.
The patient should be provided with the same instructions as those given to a
patient who is receiving penicillin (see Penicillin and Patient Education). Advise
the patient to report any hearing problem including ringing or buzzing in the ears
as well as dizziness, numbness, tingling, twitching, or changes in urinary pat-
terns especially blood in the urine.
Aminoglycosides and Drug-Drug Interactions
Aminoglycosides can have undesirable interactions with other medications.
When taken with other aminoglycosides or capremycin (Capastat) the patient
has an increased potential for hearing, kidney, and neuromuscular problems.
Hearing loss can lead to total deafness long after the patient stops treatment
with aminoglycosides.
CHAPTER 13 Antimicrobials—Fighting Infection^229