Newer aminoglycosides--amikacin and tobramycin: an in-vitro comparison with kanamycin and gentamicin.

Tobramycin and amikacin are new aminoglycoside antibiotics which resemble gentamicin and kanamycin respectively in pharmacokinetic, toxicological, and some microbiological respects. Minimum inhibitory concentrations for these four antibiotics have been determined against 393 bacterial strains (13 species from eight genera) isolated from clinical materialKanamycin was the least active, 89% of the Pseudomonas aeruginosa strains being resistant. Resistance was also found in 21% of the Klebsiella aerogenes, 16% of the indoleproducing Proteus species, 4% of the E. coli and 3% of the Enterobacter spp. tested. Providenca stuartii strains were often resistant to gentamicin and tobramycin.Apart from these exceptions, however, all the organisms tested were sensitive to all four compounds, gentamicin and tobramycin usually showing the highest intrinsic activity.Amikacin was the most active compound against a selection of strains chosen because of their resistance to one or more of the aminoglycosides. Thus, amikacin represents a significant advance over kanamycin and seems to be superior to gentamicin in terms of its in-vitro properties. This is especially the case in those unusual circumstances when gentamicin-resistant strains are a problem. We suggest that amikacin warrants further investigation since it may prove to be a valuable alternative to gentamicin in the treatment of life-threatening infections.