Aminoglycosides are an important class of antibiotics for the treatment of aerobic, gram-negative bacteria (Pseudomonas, Acinetobacter, Enterobacter) and mycobacteria (Mycobacterium tuberculosis, M. avium), causes of serious co-infections in HIV-infected persons. Widespread use of aminoglycosides has been limited due to their toxicity (nephrotoxicity and ototoxicity) and inconvenient route of administration (intravenous or intramuscular);the adverse effects are related to plasma drug levels. For example, use of amikacin for first-line therapy is limited due to poor oral absorption, a short half-life, and serious renal and auditory toxicities which necessitate frequent intravenous administration, with concomitant monitoring of drug levels to ensure that the levels in plasma remain within a narrow therapeutic window.
