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JAC Advance Access originally published online on September 21, 2007
Journal of Antimicrobial Chemotherapy 2007 60(5):911-912; doi:10.1093/jac/dkm377
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Aminoglycoside/ß-lactam combinations in clinical practice

Leonard Leibovici1,3,* and Mical Paul1,2,3

1 Department of Medicine E, Beilinson Campus, Petah-Tiqva 49100, Israel 2 Unit of Infectious Diseases, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel 3 Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel

* Corresponding author. Tel: +972-3-9376501; Fax: +972-3-9376512; E-mail: leibovic{at}post.tau.ac.il

Randomized controlled trials failed to show an advantage of the addition of aminoglycosides to broad-spectrum ß-lactams. In the present issue of the Journal of Antimicrobial Chemotherapy, an analysis of a large series of bacteraemic patients from Denmark, treated either with a narrow-spectrum ß-lactam or with a combination of a ß-lactam and an aminoglycoside, shows comparable outcomes in the two groups. In locations where broad-spectrum ß-lactams are in common use, the addition of an aminoglycoside does not improve efficacy and adds side effects. In countries where the resistance is low enough to use ‘old’ ß-lactams, and there is an unwillingness to use broad-spectrum ß-lactams, evidence for the efficacy of combination treatment and for its role in keeping the resistance at a low level is wanting.

Keywords: synergism , Gram-negative infections , cephalosporins , penicillins


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