Aminoglycosides Although aminoglycoside use is limited due to their known nephrotoxicity, they are typically used for serious gram-negative infections and infectious endocarditis. Aminoglycosides have a long postantibiotic effect and work in a concentration-dependent bactericidal manner. Nephrotoxicity occurs with frequent repeat dosing, which leads to increased accumulation of the antibiotic in the renal parenchyma. Of the aminoglycosides, the most nephrotoxic is neomycin, followed by gentamicin, tobramycin, and amikacin.
Streptomycin appears to be the least nephrotoxic. Aminoglycoside-induced AKI includes ATN, which typically presents 5 to 7 days after initial exposure. It can also cause proximal tubular dysfunction, known as Fanconi syndrome, leading to metabolic acidosis, hypophosphatemia, glucosuria, aminoaciduria. Strategies to prevent aminoglycoside-induced AKI include using less…
