Aminoglycoside antibiotics continue to be indispensable in the management of complex aerobic gram-negative infections. In the United States approximately 4,000,000 patients receive this antibiotic class each year. Although the clinical efficacy of aminoglycosides is unsurpassed, these antibiotics nonetheless have an inherent tendency to produce undesirable side effects. In particular, nephrotoxicity and ototoxicity continue to be the toxicologic side effects that merit special concern in patient management. If careful attention is paid to the dose of an aminoglycoside, the duration of its use, and other clinical issues, such as the state of hydration of the patient, toxic side effects can be reduced to the minimum. Aminoglycosides are chemically and microbiologically ideally suited for inclusion in polymethylmethacrylate bone cements as a delivery system for prevention or treatment of orthopedic surgical infections.