Is a randomized trial of a short course of aminoglycoside added to β-lactam antibiotics for empirical treatment in critically ill patients with sepsis justified?

Short-term adjunctive treatment with aminoglycosides in critically ill patients is advocated in guidelines for the empirical treatment of sepsis, despite lack of evidence from randomized trials. A large observational study recently reported more nephrotoxicity and a trend to worse patient outcome in critically ill patients receiving aminoglycosides added to beta-lactam antibiotics. Here, we discuss if a randomized controlled trial to obtain a more definite answer is justified and how it could be performed.