Usg shows raised renal coical echogenecity suggestive of renal parenchymal disease and therefore should avoid aminoglycosides. All aminoglycosides have complication of being ototoxic and nephrotoxic. Ototoxicity and nephrotoxicity are more likely : when therapy is continued for > 5 days at higher doses Elderly renal insufficiency. Concurrent use with loop diuretics or other nephrotoxic antimicrobial agents (eg, vancomycin or amphotericin. Ototoxicity is most likely seen with: Neomycin Kanamycin amikacin vestibulotoxic agent- Streptomycin gentamicin nephrotoxic agents: Neomycin Tobramycin gentamicin