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Sir,

We thank Keuleyan and Kirilov1 for their comments and beg to differ with most of them. The question of the advantages and disadvantages of aminoglycosides compared with other drugs is discussed in our review.2 Based on observational studies, we believe that treatment with an aminoglycoside is less effective than β-lactam treatment in septic patients with Gram-negative infections in sites other than those in the urinary tract. Randomized controlled trials on aminoglycosides as single treatment (for infections other than the urinary tract) are few and included a small number of septic patients.

To the best of our knowledge, Acinetobacter spp. are not inherently resistant to aminoglycosides. Resistance is mediated through several mechanisms, mainly aminoglycoside-modifying enzymes,3 and its prevalence is dependent on local epidemiology and strain distribution. In our centre, aminoglycosides are the fourth most active antibiotic class against Acinetobacter baumannii, following colistin, carbapenems and ampicillin/sulbactam.4 Other Acinetobacter spp. are susceptible to aminoglycosides. In the SENTRY survey, more than 50% of clinical Acinetobacter spp. strains resistant to ceftazidime were susceptible to amikacin and tobramycin, which were second only to imipenem.5 In the MYSTIC survey, 58% and 53% of nosocomial Acinetobacter spp. in Europe in 2007 were susceptible to gentamicin and tobramycin, respectively.6 The data shown for the ‘usual’ in vitro spectrum of activity of aminoglycosides against Acinetobacter spp. in textbooks7 should probably be adapted to current epidemiology to avoid confusion among clinicians and microbiologists.

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