The aminoglycosides continue to be needed in hospital pediatrics. Their advantage is high predictability of both efficacy and toxicity. This review focuses on the background to the aminoglycosides and defines their present role in antibiotic therapy of pediatric patients. Both the beneficial and unfavourable characteristics of these antimicrobial agents are discussed. The clinical uses of aminoglycoside antibiotics and their possible modes of administration are also commented on. The author attempts to compare the currently available aminoglycosides gentamicin, tobramycin, amikacin and netilmicin in the light of their antibacterial activity in vitro, their clinical efficacy, and their ototoxic and nephrotoxic potential. For the future it is important not to lose sight of these backup drugs where appropriately and safely used. A possible renaissance of the aminoglycosides would require either a molecular miracle (new aminoglycosides with decreased toxicity and an increased spectrum of activity) or a bacterial revolt (rapid emergence of resistance of many gram-negative enteric bacilli to other antibiotic classes).