Aminoglycoside/ -lactam combinations in clinical practice

Randomized controlled trials failed to show an advantage of the addition of aminoglycosides to broad-spectrum beta-lactams. In the present issue of the Journal of Antimicrobial Chemotherapy, an analysis of a large series of bacteraemic patients from Denmark, treated either with a narrow-spectrum beta-lactam or with a combination of a beta-lactam and an aminoglycoside, shows comparable outcomes in the two groups. In locations where broad-spectrum beta-lactams are in common use, the addition of an aminoglycoside does not improve efficacy and adds side effects. In countries where the resistance is low enough to use 'old' beta-lactams, and there is an unwillingness to use broad-spectrum beta-lactams, evidence for the efficacy of combination treatment and for its role in keeping the resistance at a low level is wanting.