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Hearing loss and nephrotoxicity in long-term aminoglycoside treatment in patients with tuberculosis
1Faculty of Medical Sciences, University of Groningen, The Netherlands.
Objective:
To investigate the ototoxic and nephrotoxic effects of long-term use of aminoglycosides.
Design:
Patients treated for tuberculosis with aminoglycosides were evaluated for hearing loss and nephrotoxicity for a minimum of 14 days.
Results:
Hearing loss of 15 decibels (dB) at two or more frequencies, or at least 20 dB hearing loss at at least one frequency, was found in 18% of our total population treated with aminoglycosides (amikacin, kanamycin and/or streptomycin). In the group treated with kanamycin this percentage was 15.6. None of the factors sex, age, treatment duration, total aminoglycoside doses or first serum creatinine concentration, was found to be associated with hearing loss. Nephrotoxicity percentages at the end of treatment with aminoglycoside or kanamycin are 7.5% (1.9%) and 4.5% (2.3%) respectively, using the definition increase of serum creatinine > or = 27 micromol/l (> or = 44 micromol/l). Patients developing nephrotoxicity had a longer duration of treatment and received larger total doses.
Conclusions:
Patients developing nephrotoxicity had a significantly longer duration of treatment with aminoglycosides, and received a larger total dose. We did not find any factor significantly associated with the development of hearing loss. In the long-term treatment of tuberculosis with aminoglycosides, ototoxicity seems to be a greater problem than nephrotoxicity.
Insights
Long-term aminoglycoside treatment for tuberculosis can cause hearing loss in 18% of patients. While nephrotoxicity also occurs, ototoxicity is a more significant concern, with no identified risk factors for hearing impairment.
Area of Science:
- Pharmacology
- Ototoxicology
- Nephrotoxicology
Background:
- Aminoglycosides are crucial in treating tuberculosis.
- Long-term use necessitates understanding their potential toxicities.
Purpose of the Study:
- To assess the ototoxic and nephrotoxic effects of extended aminoglycoside therapy.
- To identify factors associated with these adverse events.
Main Methods:
- Evaluation of patients undergoing tuberculosis treatment with aminoglycosides.
- Monitoring for hearing loss and nephrotoxicity over a minimum of 14 days.
Main Results:
- 18% of patients experienced hearing loss (≥15 dB at two frequencies or ≥20 dB at one frequency).
- No correlation found between hearing loss and patient demographics, treatment duration, or dosage.
- Nephrotoxicity occurred in 7.5% of patients, with higher rates in those receiving kanamycin.
- Nephrotoxicity was linked to longer treatment duration and higher total doses.
Conclusions:
- Ototoxicity is a more prevalent issue than nephrotoxicity in long-term aminoglycoside tuberculosis treatment.
- Factors contributing to hearing loss remain unidentified.
- Extended treatment duration and higher cumulative doses increase nephrotoxicity risk.