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Updated: Nov 16 2021


  • Snapshot
    • A 24-year-old woman presents to the emergency room for abdominal pain and foul-smelling discharge from her vagina. About 4 days ago, she gave birth to twins via C-section and was sent home without complications. Yesterday, she developed a fever as well as abdominal pain. On physical exam, there is significant tenderness to palpation. She is started on intravenous antibiotic therapy with 2 agents, covering both anaerobes and aerobic gram-negative organisms. (Postpartum endometritis)
  • Introduction
    • Drugs
      • amikacin
      • gentamicin
      • neomycin
      • streptomycin
      • tobramycin
    • Mechanism of action
      • irreversibly binds to 30S subunit of bacterial ribosomes
        • prevents initiation complex from forming
        • causes misreading of genetic code
      • requires oxygen for uptake and is effective only against aerobes
      • works synergistically with beta-lactams
      • bactericidal
    • Mechanism of resistance
      • bacterial enzymes inactivate the drug by modifying it through adenylation, acetylation, or phosphorylation
    • Clinical use
      • severe aerobic gram-negative rod infections
        • including Pseudomonas aeruginosa, Acinetobacter, Nocardia, and Actinomycetes
        • P aeruginosa resistant to gentamicin and tobramycin are often susceptible to amikacin
      • neomycin for bowel surgery
      • topical neomycin for superficial skin infections
    • Adverse effects
      • irreversible ototoxicity (cochlear and vestibular)
        • increased with loop diuretics
      • nephrotoxicity
        • increased with cephalosporins
      • neuromuscular blockade
      • teratogen
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