Role of aminoglycoside antibiotics in the treatment of intra-abdominal infection

Aminoglycosides are widely used in the treatment of gram-negative bacillary infections, including intraabdominal infections. However, these drugs may produce side effects of nephrotoxicity and ototoxicity, particularly when there is volume depletion, shock, advanced age, or renal impairment (23), risk factors which are common in patients with intra-abdominal infection. The impact of treatment with aminoglycosides on the incidence of nephrotoxicity, as evidenced by an elevation in the serum creatinine concentration, in patients with intra-abdominal infection is shown in Table 1. There was an appreciably higher incidence of nephrotoxicity with the aminoglycoside-containing regimen in four randomized trials; the effect was statistically significant in at least two studies. Aminoglycoside-induced ototoxicity is potentially more important than nephrotoxicity because it is often not reversible. Cochlear toxicity, as defined by audiometric changes, has been reported in 8 to