Aminoglycosides: how should we use them in the 21st century?Jackson, Justina; Chen, Carolineb; Buising, Kirstya,b,cCurrent Opinion in Infectious Diseases: December 2013 - Volume 26 - Issue 6 - p 516–525 doi: 10.1097/QCO.0000000000000012 ANTIMICROBIAL AGENTS: Edited by Monica A. Slavin and Deenan Pillay Abstract Author Information Purpose of review Aminoglycoside antibiotics (AGAs) have proved an invaluable part of our antimicrobial armamentarium since their introduction into practice over 60 years ago. This review summarizes recent developments, defining their role in the context of the current global epidemic of antibiotic resistance, raising awareness of their toxicity profile, and highlighting current data on their utility as synergistic agents. Recent findings Clinicians are facing an unprecedented threat from antibiotic resistance, resulting in an increased reliance on the addition of an AGA to provide adequate empirical cover in cases of severe sepsis. Concurrently, an increased awareness of the potential for severe disability, particularly from vestibular toxicity, has restrained directed therapy of AGAs to situations in which there are no appropriate alternatives. Their role as synergistic agents in the treatment of enterococcal endocarditis is currently under reevaluation, and new data have emerged on combination therapy for Pseudomonas aeruginosa bacteremia. AGAs are themselves coming under increasing threat from resistance, predominately from aminoglycoside modifying enzymes (mediating selective resistance) and 16S rRNA methyltransferases (conferring class-wide resistance). New agents and the development of alternate ways to circumvent resistance are likely to have important roles in future clinical care. Summary Aminoglycosides retain an invaluable but well defined role, and will remain important agents into the foreseeable future. aDepartment of Infectious Diseases, St Vincent's Hospital bVictorian Infectious Disease Service, The Royal Melbourne Hospital cThe University of Melbourne, Melbourne, Victoria, Australia Correspondence to Kirsty Buising, Associate Professor, The University of Melbourne, Grattan Street, Parkville, Victoria 3050, Australia. Tel: +61 393427212; e-mail: firstname.lastname@example.org © 2013 Lippincott Williams & Wilkins, Inc.