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Abstract
The introduction of gentamicin almost 20 years ago provided an effective option for
the treatment of gram-negative bacillary infections. During the past few years, the
availability of aztreonam (a monobactam), imipenem (a carbapenem), and newer cephalosporins
within vitro activities comparable with aminoglycosides against many gram-negative
bacilli, has stimulated a reassessment of the role of aminoglycosides in treating
these infections. When determining the role of new antimicrobials as potential replacements
for more established agents, the clinical focus should be on three factors: comparative
efficacy, safety, and cost. Consideration of cost is relevant only when efficacy and
safety are equivalent. Other factors, such as comparative in vitro antimicrobial activity,
pharmacokinetics, and effect on normal flora can also influence the selection of an
antimicrobial regimen.
A new class of antimicrobials, the monobactams, is the focus of this review. The only
member of this class currently in clinical use is aztreonam. A comparison with aminoglycosides
is particularly relevant because aztreonam is active against aerobic gram-negative
bacilli. This review will discuss the acknowledged concerns with aminoglycoside use
and compare the characteristics of aztreonam and currently marketed aminoglycosides.
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© 1989 Published by Elsevier Inc.
