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Toxicity of single daily dose gentamicin in stem cell transplantation

D Warkentin1, C Ippoliti, J Bruton

  • 1CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Center, University of British Columbia, Vancouver, Canada.

Bone Marrow Transplantation
|August 6, 1999
PubMed

Insights

Single daily dose gentamicin in stem cell transplant recipients showed a 12% ototoxicity rate. Prolonged therapy (>10 days) significantly increased this risk, suggesting careful monitoring is essential for this antibiotic regimen.

Area of Science:

  • Pharmacology
  • Oncology
  • Nephrology

Background:

  • Gentamicin is frequently used for febrile neutropenia in stem cell transplantation (SCT).
  • Single daily dosing (SDD) is a common administration method for gentamicin.
  • The safety profile of SDD gentamicin, particularly ototoxicity, requires further investigation in SCT patients.

Purpose of the Study:

  • To evaluate the safety of single daily dose (SDD) gentamicin in adult patients undergoing stem cell transplantation (SCT).
  • To determine the incidence of nephrotoxicity and ototoxicity associated with SDD gentamicin therapy in this population.

Main Methods:

  • Retrospective evaluation of 33 adult SCT patients receiving SDD gentamicin (5 mg/kg i.v. every 24 h) for febrile neutropenia.
  • Concurrent use of vancomycin and, in some cases, cisplatin was noted.
  • Monitoring of serum gentamicin levels was performed upon renal function deterioration.

Main Results:

  • The incidence of nephrotoxicity was 3%, and clinically significant ototoxicity was 12%.
  • Patients who developed ototoxicity had a significantly longer mean duration of gentamicin therapy (20 days vs. 9 days).
  • Treatment with SDD gentamicin for over 10 days was associated with a higher likelihood of ototoxicity (P = 0.045).

Conclusions:

  • Single daily dose gentamicin is associated with a 12% incidence of clinically significant ototoxicity in SCT recipients.
  • Prolonged therapy (>10 days) with SDD gentamicin appears to be a risk factor for ototoxicity.
  • Further research, potentially larger randomized trials, is needed to clarify the risks and optimize gentamicin dosing strategies in SCT patients, considering factors like duration and concomitant medications.

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