[The role of aminoglycosides in HIV-infected patients]

Abstract

The frequency of serious infections due to Pseudomonas aeruginosa is increasing among patients with advanced HIV infection; most of the cases are community-acquired. Early diagnosis and adequate treatment--usually with the combination of an anti-pseudomonas beta-lactam antibiotic and an aminoglycoside--have a crucial bearing on prognosis. The good in vitro activity of aminoglycosides against mycobacteria contrasts with the need for intravenous administration and toxicity. In patients with Mycobacterium avium complex infection, amikacin should be given only in the event of difficulty with an oral regimen and only on a temporary basis. Similar rules apply to the treatment of multiresistant tuberculosis with streptomycin or amikacin. Paromomycin is not absorbed by the gastrointestinal tract when taken orally, constitutes the treatment of choice against cryptosporidiosis and serves as an alternative against Entamoeba histolytica and Giardia lamblia. Topical treatment with paromomycin ointment can be used in cutaneous leishmaniasis.