The commonly used aminoglycoside antibiotics, kanamy-cin, gentamicin, streptomycin, tobramycin, and amikacin, interfere with protein synthesis by binding to the 30S ribosomal subunit. Resistance to aminoglycosides is usually mediated by inactivation of the antibiotic by glycoside-modifying enzymes. The covalent modification of aminoglycosides can be carried out by aminoglycoside acetyltransferases, aminoglycoside nucleotidyltrans-ferases, or aminoglycoside phosphotransferases. There are also reports of aminoglycoside resistance mediated by mutations to ribosomal RNA, or by active efflux systems.[2'5]

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