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The primary concern when using aminoglycosides is nephrotoxicity and ototoxicity. Aminoglycosides, such as gentamicin, tobramycin, and amikacin, are a class of antibiotics used primarily to treat serious infections caused by gram-negative bacteria.

Nephrotoxicity is a significant risk because aminoglycosides can cause damage to the kidneys, leading to reduced renal function, which may be reversible or irreversible depending on the duration and dosage of treatment. It is crucial to monitor renal function through serum creatinine levels and adjust dosages accordingly to minimize this risk.

Ototoxicity refers to the potential for these drugs to cause injury to the inner ear structures, resulting in hearing loss or balance issues. This effect can also be dose-dependent and is particularly concerning in patients receiving high doses or prolonged courses of treatment.

While hepatotoxicity, gastrointestinal upset, and cardiac arrhythmias can be associated with other medications or conditions, they are not the primary concerns specific to aminoglycosides. The focus on nephrotoxicity and ototoxicity is critical due to the need for vigilant monitoring and the potential for these adverse effects to lead to significant morbidity.