Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Signs of toxicity to monitor in patients receiving aminoglycosides include:
- Nephrotoxicity: Look for rising serum creatinine and reduced urine output, indicating acute kidney injury. Aminoglycosides accumulate in renal proximal tubular cells causing nephrotoxicity, which is often reversible if detected early NICE NG195.
- Ototoxicity: Monitor for symptoms such as tinnitus, hearing loss, vertigo, or imbalance. These signs reflect cochlear and vestibular toxicity, which may be irreversible if not identified promptly NICE NG195.
- Neuromuscular blockade: Although rare, watch for muscle weakness or respiratory depression, especially in patients with underlying neuromuscular disorders or those receiving concurrent neuromuscular blocking agents NICE NG195.
- Laboratory monitoring: Therapeutic drug monitoring (TDM) aims to maintain aminoglycoside serum concentrations within a therapeutic range to avoid toxicity. Elevated trough levels correlate with increased risk of nephro- and ototoxicity Abdul-Aziz et al. 2022.
Regular clinical assessment combined with TDM is essential to detect early toxicity signs and adjust dosing accordingly to prevent permanent damage NICE NG195; Abdul-Aziz et al. 2022. In neonates, particular vigilance is required due to immature renal function and increased susceptibility to toxicity Touw et al. 2009.