Empirical therapy

Empirical antimicrobial therapy describes the early use of broad-spectrum antimicrobials (i.e. those targeting a large variety of microbes) for infections caused by unidentified pathogen(s).

Aminoglycoside antibiotics are used in empirical therapy for a selection of infections. UTIs are often caused by multidrug-resistant (MDR) Gram-negative organisms, and aminoglycosides can be an option for a selection of patients with these infections where other antibiotics are impractical or contraindicated and based on local antimicrobial resistance data.

Take a look at the image below to explore infection types that are commonly managed with empirical therapy.

If you require a screen reader-compatible version this is available as a PDF.

Aminoglycosides achieve a high concentration in the urinary tract, and in some cases (particularly with amikacin), retain activity against some Gram-negative organisms which are resistant to many other classes of antibiotics. The majority of published experience with such use is in the treatment of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae.

Unlike in the urinary tract, aminoglycosides do not reach high concentrations in the cerebrospinal fluid. In the rare cases where such therapy is required for meningitis caused by aerobic Gram-negative bacilli in adults, intraventricular administration is recommended. However, in neonates, the penetration of the drug is much greater and intraventricular administration is no more effective and may even be more toxic than intravenous administration of the drug.

In the next step, we will explore a case study to learn more about which aminoglycoside antibiotics are used empirically.