What is the drug list of aminoglycosides? A comprehensive guide

October 8, 2025 •

3 min read

According to the Merck Manual, aminoglycosides are a class of antibiotics used to treat serious bacterial infections, particularly those caused by gram-negative bacteria. Knowing what is the drug list of aminoglycosides is crucial for understanding their powerful, yet carefully managed, role in modern medicine. These medications work by targeting bacterial protein synthesis, but their use is limited by potential toxicities.

Quick Summary

A guide to the list of aminoglycoside medications, detailing their primary uses for serious bacterial infections and notable side effects. It covers key drugs like gentamicin and amikacin, their mechanism of action, and important considerations for patient safety.

Key Points

Drug List: Key aminoglycoside antibiotics include gentamicin, tobramycin, amikacin, neomycin, streptomycin, paromomycin, and plazomicin.
Clinical Use: Aminoglycosides are primarily used for severe infections caused by aerobic gram-negative bacteria, but can be combined with other antibiotics for specific gram-positive infections.
Mechanism: These drugs kill bacteria by binding to the 30S ribosomal subunit, causing misreading of genetic code and inhibiting protein synthesis.
Major Side Effects: The most significant adverse effects are nephrotoxicity (kidney damage) and ototoxicity (hearing and balance issues).
Formulations: Most aminoglycosides are given intravenously or intramuscularly, while some, like neomycin and paromomycin, have topical or oral forms with limited systemic absorption.
Monitoring is Key: Due to their toxicity, close monitoring of drug levels and patient organ function is crucial during treatment.

Aminoglycosides are a powerful class of antibiotics highly effective against many aerobic gram-negative bacteria. Due to poor absorption in the gastrointestinal tract, most require intravenous or intramuscular administration. However, some preparations exist for topical, ophthalmic, or oral use for specific conditions.

The comprehensive drug list of aminoglycosides

Common clinically used aminoglycoside drugs include:

Gentamicin: Often prescribed for severe infections like septicemia, meningitis, and complicated urinary tract infections. Available in various forms including topical and ophthalmic.
Tobramycin: Frequently used for serious gram-negative infections, especially those caused by Pseudomonas aeruginosa. Inhalation forms treat Pseudomonas in cystic fibrosis patients.
Amikacin: Effective against bacteria resistant to other aminoglycosides and used for mycobacterial infections like tuberculosis.
Neomycin: Primarily for local effects due to poor systemic absorption. Oral forms treat hepatic encephalopathy and for bowel preparation; topical neomycin is used for skin infections.
Streptomycin: Used for tuberculosis and plague.
Paromomycin: Oral, poorly absorbed, used for intestinal amebiasis and hepatic encephalopathy management.
Plazomicin: A newer option for complicated urinary tract and other infections caused by multi-drug resistant bacteria.

Mechanism of action

Aminoglycosides kill bacteria by disrupting protein synthesis. They bind to the bacterial 30S ribosomal subunit, causing misreading of mRNA and production of faulty proteins that damage the cell membrane.

Spectrum and synergy

These antibiotics are most effective against aerobic gram-negative bacteria. They are not effective against anaerobic bacteria due to the oxygen requirement for transport. They can be used with cell-wall inhibitors like penicillin or vancomycin for synergistic effect against some gram-positive infections like endocarditis.

Major adverse effects

Systemic aminoglycosides carry a risk of serious adverse effects, mainly affecting the kidneys and inner ear.

Nephrotoxicity (Kidney Damage): This is common and usually reversible after stopping the drug. Factors increasing risk include kidney disease and concurrent use of other nephrotoxic drugs. Monitoring kidney function is vital.
Ototoxicity (Inner Ear Damage): Can lead to permanent hearing loss or balance issues. Tinnitus or vertigo can be early signs. Gentamicin and streptomycin are linked to vestibular damage, while amikacin can cause cochlear damage.
Neuromuscular Blockade: Rare, but can cause muscle weakness, especially with rapid IV administration or in patients with certain muscular disorders.

Comparison of key aminoglycosides


Drug	Primary Uses	Common Formulations	Special Considerations
Gentamicin	Severe gram-negative infections, sepsis, meningitis, endocarditis	IV, IM, Topical, Ophthalmic	Most common systemic use; significant vestibular ototoxicity risk
Tobramycin	Pseudomonas aeruginosa infections, cystic fibrosis	IV, IM, Inhalation, Ophthalmic	Greater anti-Pseudomonas activity in vitro than gentamicin
Amikacin	Multi-drug resistant infections, tuberculosis	IV, IM	Used for organisms resistant to other aminoglycosides; significant cochlear ototoxicity risk
Neomycin	Hepatic encephalopathy, bowel prep, skin infections	Oral, Topical	Poorly absorbed systemically; limited to local effects
Streptomycin	Tuberculosis, plague	IM	First discovered aminoglycoside; primarily reserved for specific resistant infections

Conclusion

Key aminoglycosides like gentamicin, tobramycin, and amikacin are potent antibiotics reserved for serious bacterial infections due to potential toxicity. Others like neomycin and paromomycin are used for localized effects due to poor systemic absorption. These drugs are important in treating multi-drug resistant bacteria, but require careful monitoring for nephrotoxicity and ototoxicity. Healthcare professional supervision is essential for their safe and effective use.

For more detailed clinical information on these medications, refer to the UpToDate article on Aminoglycosides.

Frequently Asked Questions

The primary aminoglycosides used systemically for severe infections include gentamicin, tobramycin, and amikacin, which are typically administered via intravenous or intramuscular injection.

Yes, some aminoglycosides like neomycin and paromomycin are given orally. However, they are poorly absorbed systemically and are therefore used to treat infections within the gastrointestinal tract, rather than systemic infections.

The most common and serious side effects are ototoxicity, which affects hearing and balance, and nephrotoxicity, which involves kidney damage. Both effects are related to the dosage and duration of treatment.

Aminoglycosides are often combined with other antibiotics, such as beta-lactams, to achieve a synergistic effect. This combination can be particularly effective against certain severe gram-positive infections, like bacterial endocarditis.

Amikacin is often the preferred aminoglycoside for infections caused by bacteria that have developed resistance to other drugs in the class, due to its unique chemical structure that makes it less susceptible to bacterial inactivation.

Aminoglycosides are used for a variety of serious infections, including septicemia, meningitis, complicated urinary tract infections, and infections of the skin and abdomen, especially those caused by aerobic gram-negative bacteria.

Monitoring drug levels is essential for aminoglycosides due to their narrow therapeutic window. This ensures that peak concentrations are high enough to effectively kill bacteria, while trough levels are low enough to minimize the risk of serious side effects like ototoxicity and nephrotoxicity.