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Published by: awajahat on Jul 18, 2009
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From Wikipedia, the free encyclopedia
is a molecule composed of a sugar group and anamino group.
Several aminoglycosides function as antibioticsthat are effective against certain types of   bacteria. They includeamikacin,arbekacin, gentamicin,kanamycin, neomycin, netilmicin, paromomycin,rhodostreptomycin
,streptomycin,tobramycin, and apramycin.Anthracyclinesare another group of aminoglycosides. These compounds are used inchemotherapy.
[edit] Nomenclature
Aminoglycosides that are derived from bacteria of the 
 genusare namedwith the suffix
, while those which are derived from
are namedwith the suffix
.This nomenclature system is not specific for aminoglycosides. For example vancomycinis a glycopeptideantibiotic anderythromycin, which is produced from a species of 
(which was previously misclassified as
) along with its
synthetic derivativesclarithromycinandazithromycin aremacrolides- all of which differ  in their mechanisms of action.
[edit] Antibiotic mechanism of action
Aminoglycosides antibiotics work by binding to the bacterial 30S ribosomal subunit
(some work by binding to the50Ssubunit
), inhibiting the translocation of the peptidyl-tRNA from the A-site to the P-site and also causing misreading of mRNA, leaving the bacterium unable to synthesize proteins vital to its growth. They kill bacteria byinhibiting protein synthesis as they bind to the 16S rRNA and by disrupting the integrityof bacterial cell membrane.
However, their exact mechanism of action is not fullyknown.There is a significant relationship between the dose administered and the resultant plasmalevel in blood. TDM, therapeutic drug monitoring, is necessary to obtain the correct dose.These agents exhibit a post-antibiotic effect in which there is no or very little drug levelsdetectable in blood, but there still seems to be inhibition of bacterial re-growth. This isdue to strong, irreversible binding to the ribosome, and remains intracellular long after  plasma levels drop. This allows a prolonged dosage interval. Depending on their concentration they act as bacteriostaticor  bactericidalagents. The protein synthesis inhibition of aminoglycosides does not usually produce a bactericidal effect, let alone a rapid one as is frequently observed on susceptible Gram-negative bacilli. Aminoglycosides competitively displace cell biofilm-associated Mg
and Ca
that link the polysaccharides of adjacent lipopolysaccharide molecules. "Theresult is shedding of cell membrane blebs, with formation of transient holes in the cellwall and disruption of the normal permeability of the cell wall. This action alone may besufficient to kill most susceptible Gram-negative bacteria before the aminoglycoside hasa chance to reach the 30S ribosome
."Traditionally, the antibacterial properties of aminoglycosides were believed to result frominhibition of bacterial protein synthesis through irreversible binding to the 30S bacterialribosome. This explanation, however, does not account for the potent bactericidal properties of these agents, since other antibiotics that inhibit the synthesis of proteins(such as tetracycline) are not bactericidal. Recent experimental studies show that theinitial site of action is the outer bacterial membrane. The cationic antibiotic moleculescreate fissures in the outer cell membrane, resulting in leakage of intracellular contentsand enhanced antibiotic uptake. This rapid action at the outer membrane probablyaccounts for most of the bactericidal activity.2 Energy is needed for aminoglycosideuptake into the bacterial cell. Anaerobes have less energy available for this uptake, soaminoglycosides are less active against anaerobes. Aminoglycosides are useful primarilyin infections involvingaerobic,gram-negative  bacteria, such as
. In addition, some
, including the bacteriathat causetuberculosis, are susceptible to aminoglycosides. The most frequent use of aminoglycosides is empiric therapy for serious infections such as septicemia, complicatedintraabdominal infections, complicated urinary tract infections, and nosocomial
respiratory tract infections. Usually, once cultures of the causal organism are grown andtheir susceptibilities tested, aminoglycosides are discontinued in favor of less toxicantibiotics.Streptomycin was the first effective drug in the treatment of tuberculosis, though the roleof aminoglycosides such as streptomycin and amikacin has been eclipsed (because of their toxicity and inconvenient route of administration) except for multiple drug resistantstrains.Infections caused bygram-positive  bacteria can also be treated with aminoglycosides, but other types of antibiotics are more potent and less damaging to the host. In the past theaminoglycosides have been used in conjunction with beta-lactam antibiotics instreptococcal infections for their synergistic effects, particularly inendocarditis. One of the most frequent combinations is ampicillin (a beta-lactam, or penicillin-relatedantibiotic) and gentamicin. Often, hospital staff refer to this combination as "amp andgent" or more recently called "pen and gent" for penicillin and gentamicin.Aminoglycosides are mostly ineffective against anaerobic bacteria, fungi and viruses.Experimentation with aminoglycosides as a treatment of  cystic fibrosis(CF) has shown some promising results. CF is caused by a mutation in the gene coding for the 
) protein. In approximately 10% of CF cases the mutation in this gene causes its early termination duringtranslation, leadingto the formation of is truncated and non-functional CFTR protein. It is believed thatgentamicin distorts the structure of the ribosome-RNA complex, leading to a mis-readingof thetermination codon,causing the ribosome to "skip" over the stop sequence and to continue with the normal elongation and production of the CFTR protein. The treatmentis still experimental but showed improvement in cells from CF patients with susceptiblemutations.
[edit] Routes of administration
Since they are not absorbed from the gut, they are administeredintravenouslyandintramuscularly.Some are used in topical preparations for wounds. Oral administrationcan be used for gut decontamination (e.g. in hepatic encephalopathy). Tobramycin may be administered in a nebulized form.
) are bactericidal. They bind to the 30S ribosome,thereby inhibiting bacterial protein synthesis.
Aminoglycosides are poorly absorbed orally but are well absorbed from the peritoneum, pleural cavity, joints (and shouldnever be instilled in these body cavities), and denuded skin. Aminoglycosides are distributed well into the ECF except for vitreous humor,CSF, respiratory secretions, and bile (particularly with biliary obstruction).

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