Aminoglycosides for Cystic Fibrosis

Aminoglycosides are a group of antibiotics indicated for the management of acute exacerbations in CF patients and to treat Pseudomonas aeruginosa infections. They work by preventing bacterial protein synthesis. Tobramycin, amikacin and gentamicin are the main aminoglycosides.1

History of aminoglycosides

The first aminoglycoside, streptomycin, was introduced in 1944. It was isolated from a strain of Streptomyces griseus during a search for antibacterial substances after the discovery of penicillin. Gentamicin was isolated from a mold (Micromonospora purpurea) in 1963; tobramycin was produced from Streptomyces tenebrarius in 1967; and amikacin, a semisynthetic derivative of kanamycin, was introduced in 1972.

The aminoglycosides consist of two or more amino sugars connected to a nucleus, and they are distinguished by their amino sugars.2

How aminoglycosides work

Aminoglycosides kill bacteria by stopping protein synthesis, thus altering the integrity of the bacterial cell membrane.

They bind to the bacterial 30S ribosomal subunit. Ribosomes are the protein factories of cells. They are composed of two subunits in bacteria: a 30S and a larger 50S. When binding to the ribosome, aminoglycosides stop protein synthesis that is necessary for growth.

Aminoglycosides kill bacteria because they displace molecules in the bacterial cell wall, creating holes that may kill the bacteria even before the aminoglycoside reaches the ribosome.3

Other details about aminoglycosides

Aminoglycosides are poorly absorbed orally, so they need to be administered intravenously.

This group of antibiotics is used when other, less toxic antibiotics are contraindicated or ineffective. They may cause serious kidney, hearing, or other problems, especially in older people.

Common side effects are nausea, vomiting, diarrhea, pain at the injection site, headache, and fever. Emergency medical treatment should be sought if any of the following symptoms are experienced: rash; peeling or blistering of the skin; itching; hives; swelling of the eyes, face, throat, tongue or lips; difficulty breathing or swallowing; or hoarseness.

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