Aminoglycosides


Aminoglycosides are broad-based heterosides with a broad-spectrum antibiotic action.
 
Streptidine group
 
Streptomycin, dihydrostreptomycin, hydroxystreptomycin, manosidostreptomycin.
 
Desoxystreptamine group
 
1,3 substitution (trisaccharide): kanamycin, amikacin, gentamicin, tobramycin, sisomicin, netilmicin.
 
1,2 substitution (tetrasaccharide): paramomycin, neomycin.
 
Incidence
High for neomycin and streptomycin: >2% of treatments.
 
Occasional for gentamicin and amikacin: 0.1 to 2% of treatments.
 
Uncommon for kanamycin: 0.1 to 0.5% of treatments.
 
Clinical manifestations
General: anaphylactic shock uncommon, fever (11% with long-term streptomycin), serum sickness.
 
Cutaneous: urticaria, rash (11% with streptomycin; 0.8% with gentamicin; 0.6% with tobramycin), contact dermatitis (3 to 10% with streptomycin), exfoliative dermatitis.
 
Haematological: eosinophilia, immunological blood dyscrasia.
 
Diagnostic methods
Cutaneous testing
 
Skin prick-tests: one case positive with systemic reaction in a patient with anaphylactic shock following topical use of framycetin (framycetin sulfate 10 mg/ ml).
 
Patch-tests:
  • positive in 12% of patients treated with streptomycin.
  • positive in patients presenting contact dermatitis, rash, fever.
  • positive with neomycin in 10 to 35% of patients with leg ulcers.

The presence of antibodies against specific aminosides has rarely been demonstrated.

  • antistreptomycin IgG antibodies in association with hemolytic anemia (direct and indirect Coombs);
     
  • antierythrocyte antibodies (neomycin, gentamicin, kanamycin).
Mechanisms
IgE-mediated hypersensitivity (rare).
 
Cell-mediated delayed hypersensitivity for contact dermatitis (neomycin) ; neomycin is the antibiotic with the highest contact sensitizing power. Sensitization tends to occur on altered skin (leg ulcers) and with long-term application.
 
Management
Avoid use of offending antibiotics for leg ulcers. The use of neomycin should be avoided in dermatology.
 
Cross sensitivity between aminosides has been documented (neomycin-framycetin: 93% ; neomycin-ribostamycin 73% ; neomycin-kanamycin 60% ; neomycin-gentamycin 46% ; neomycin-tobramycin 40%).

References

  1. Assier-Bonnet H, Revuz J, "La néomycine topique, risques et bénéfices. Plaidoyer pour un retrait", Ann. Dermatol. Venereol., 1997 ; 124: 721-5
  2. Proebstle T.M, Jugert F.K, Merk H.F, Gall N, "Severe anaphylactic reaction to topical administration of framycetin", J. Allergy. Clin. Immunol., 1995 ; 96 (3): 429-30
  3. Samsoen M, Metz R, Melchior E, Foussereau J, "Allergie croisée entre les antibiotiques aminosides", Ann. Dermatol. Venereol., 1979 ; 106 (8-9): 683-9
  4. Chung C.W, Carson T.R, "Cross sensitivity of common aminoglycoside antibiotics", Arch. Dermatol., 1976 ; 112: 1101-7.
  5. Rippen R.P, "Anaphylactic reaction after Chymacort® ointment". Br. Med. J., 1966 ; 1: 1172.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.