What are the adverse reactions of aminoglycoside antibiotics?

Otototoxicity includes vestibular dysfunction and auditory nerve injury. Among them, vestibular dysfunction is manifested as dizziness, nausea, vomiting, nystagmus and balance disorder, and its incidence rate is neomycin. Kanamycin >; Streptomycin >; Sisomicin > gentamicin > tobramycin > netilmicin. Auditory nerve injury is characterized by hearing loss or deafness, and its incidence rate is neomycin >: kanamycin >; Amikacin >; Sisomicin > Gentamicin > Tobramycin > Streptomycin should pay attention to the "subclinical ototoxicity" reaction that can only be displayed by instrument monitoring. The mechanism of ototoxicity is related to the fact that high concentration drugs hinder the glucose metabolism and energy utilization of hair cells inside and outside Corti's organ of inner ear, resulting in the dysfunction of cell membrane Na+-K+-ATPase and the damage of hair cells.

In order to prevent and reduce ototoxicity, patients should always be asked whether they have early symptoms such as tinnitus and dizziness when using such antibiotics, and their hearing should be monitored. Use ototoxic drugs (furosemide, itaconic acid, erythromycin, mannitol, antiemetics, cisplatin, etc. At the same time, we should avoid using antihistamines that can cover up its ototoxicity, such as diphenhydramine, mecrolizine, bucolizine, etc., and pay attention to the dosage. It is best to monitor the plasma concentration of the therapeutic dose so that the peak concentration of the drug does not exceed 12mg/L and the trough concentration.

renal toxicity

The occurrence of nephrotoxicity is due to the relationship between renal excretion and renal cortex accumulation, which mainly damages the epithelial cells of proximal convoluted tubule. Urine is difficult to concentrate at the initial stage of poisoning, followed by proteinuria and tubular urine, and in severe cases, azotemia and anuria may occur. The incidence rate is neomycin >: tobramycin > gentamicin, netilmicin and amikacin >: streptomycin has low nephrotoxicity.

At the same time, drugs that can increase nephrotoxicity (cephalosporin, dextran, cycloserine, vancomycin, polymyxin, bacitracin, amphotericin B, etc. ) should be avoided, and should pay attention to the dose and monitor the blood concentration.

Neuromuscular blocking effect

It can cause myocardial inhibition, blood pressure drop, limb paralysis and respiratory failure, which is related to the dosage and route of administration. It is common after a large dose of intraperitoneal or pleural application and occasionally after intramuscular or intravenous injection. The incidence of tobramycin > gentamicin > amikacin and kanamycin >; Streptomycin >; Neomycin >; Netemi star。 The reason may be that drugs complexed with calcium ions or competed with calcium ions, which inhibited the release of acetylcholine from nerve endings and reduced the sensitivity of postsynaptic membrane to acetylcholine, thus blocking the transmission at neuromuscular junction. It is easy to have renal insufficiency and hypocalcemia, and to use muscle relaxants and general anesthetics at the same time, especially in patients with myasthenia gravis.

Calcium gluconate and neostigmine can reverse this blocking. Intravenous administration of aminoglycoside antibiotics is not recommended, so as to avoid sudden increase in blood concentration, causing respiratory arrest and death.

Other adverse reactions

Allergy, occasionally severe anaphylactic shock, especially streptomycin.

Other reactions, such as neutropenia and thrombocytopenia, anemia, elevated serum transaminase, facial numbness and peripheral neuritis.