Aminoglycosides can cause irreversible injury to sensory cells of the inner ear, resulting in hearing loss and disturbed balance. Tinnitus is often the first sign of damage, as these drugs damage the 8th cranial nerve. Patients should be educated on the signs and symptoms of tinnitus or balance problems and be instructed to notify their healthcare provider immediately if they experience any. The side effect of ototoxicity is increased when aminoglycosides are used concurrently with loop diuretics.
The use of aminoglycosides, especially when used in combination with cephalosporins, can cause nephrotoxicity. Therefore, this drug combination should be avoided when possible and kidney function should be monitored. Caution should be used in patients with existing renal disease.
This drug class can lead to dose-related muscular weakness or neuromuscular blockade, which can rarely progress to respiratory paralysis. This can be troublesome in patients receiving general anesthetics and neuromuscular blocking agents, or patients with neuromuscular diseases such as myasthenia gravis.
Aminoglycosides are known teratogens and are in pregnancy category D, meaning there is positive evidence of human fetal risk; therefore, they should not be used in pregnant women. Teratogens are agents that cause a defect or malformation in the development of the embryo or fetus. Aminoglycosides are especially associated with causing hearing deficits.
The same aminoglycoside dose can produce different plasma levels in different patients; therefore, a peak and trough must be done while patients are receiving this medication. Peak levels must be high enough to cause bacterial death, while trough levels must be low enough to minimize toxicity.
High concentrations of penicillins can inactivate aminoglycosides. Therefore, the two should never be mixed in the same IV solution. This interaction does not occur in the body, and these antibiotics actually have a synergistic effect in fighting bacterial infections. Thus, they should be administered separately.
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