Review on Aminoglycosides: A Comphrehensive Review of Mechanism, Clinical Efficacy and Future Prospects

Aminoglycosides are an important group of antibiotics mainly used to treat serious infections caused by aerobic Gram-negative bacteria. They are valued for their rapid and strong bactericidal action and their synergistic effect when combined with other antibiotics. These drugs act by irreversibly binding to the 30S ribosomal subunit, leading to inhibition of protein synthesis, misreading of mRNA, and bacterial cell death. Pharmacokinetically, aminoglycosides show poor oral absorption, limited tissue penetration, renal elimination, concentration-dependent killing, and a prolonged post-antibiotic effect, which influence dosing and monitoring. They are commonly used in life-threatening infections such as septicemia, pneumonia, urinary tract infections, intra-abdominal infections, and tuberculosis, but their use is restricted due to major adverse effects, especially nephrotoxicity and ototoxicity. Resistance develops through enzymatic inactivation, reduced uptake, and ribosomal alterations, prompting research into newer derivatives, optimized dosing, drug delivery systems, and combination therapies to reduce toxicity and overcome resistance in the era of rising antimicrobial resistance.