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The prevention of aminoglycoside resistance by the use of amikacin as the primary hospital aminoglycoside


, : The prevention of aminoglycoside resistance by the use of amikacin as the primary hospital aminoglycoside. Advances in Therapy 4(1): 33-39

The extensive use of gentamicin or tobramycin has resulted in widespread aminoglycoside nationally. Several investigators have suggested using amikacin as the primary hospital aminoglycoside to decrease aminoglycoside resistance and/or preserve the usefulness of aminoglycoside antibiotics. To determine the relationship of aminoglycoside usage to the development of aminoglycoside resistance in a 550 bed university affiliated community hospital, a prospective surveillance program was initiated in 1980. Gentamicin was used as the primary hospital aminoglycoside during the initial five-month baseline (1980). From 1981 to 1986 amikacin was used as the primary hospital aminoglycoside because of its favorable cost benefit ratio, therapeutic effectiveness, superior pharmacokinetic profile, and to prevent the emergence of aminoglycoside resistant gram-negative bacilli. Gram-negative isolates obtained during the baseline period were tested for amikacin susceptibility and all gram-negative organisms isolated during the amikacin surveillance phase were tested for susceptibility to amikacin, gentamicin, and tobramycin. Only 1% (12 of 1,250) of the organisms isolated during the baseline period were resistant to amikacin. After five years of general use, overall aminoglycoside resistance of gram-negative aerobic bacilli has not increased in our institution. The results of this study support the findings of others demonstrating that the routine use of amikacin does not promote aminoglycoside resistance. Morever, the general use of amikacin does not decrease the sensitivity of amikacin against nosocomial gram-negative bacilli. The results of this study also suggest that the use of amikacin as the primary hospital aminoglycoside may prevent the emergence of widespread aminoglycoside resistance to gentamicin, tobramycin, and amikacin.

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