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Related Experiment Videos

Sensorineural hearing loss associated with intrathecal vancomycin.

Olga M Klibanov1, Joanne E Filicko, Joseph A DeSimone

  • 1Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA, USA. oklibanov@hotmail.com

The Annals of Pharmacotherapy
|December 31, 2002
PubMed
Summary

Intrathecal vancomycin, used for meningitis, may cause permanent hearing loss. This case highlights a potential risk associated with this antibiotic delivery method, emphasizing careful patient monitoring.

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Ototoxicology

Background:

  • Vancomycin is commonly used intravenously for bacterial infections.
  • Ototoxicity from vancomycin is a known but rare side effect, primarily documented with systemic administration.
  • Intrathecal vancomycin is used for central nervous system infections, particularly when conventional treatment fails.

Observation:

  • A patient with acute lymphocytic leukemia developed meningitis requiring treatment with both intravenous and intrathecal vancomycin.
  • The patient experienced progressive bilateral sensorineural hearing loss after receiving two doses of intrathecal vancomycin.
  • Audiogram confirmed cranial nerve VIII damage, indicating irreversible hearing impairment.

Findings:

  • This case presents the first documented instance of ototoxicity potentially linked to intrathecal vancomycin administration.

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  • While cerebrospinal fluid vancomycin levels were not measured, the temporal relationship and exclusion of other causes support a possible drug-induced effect.
  • The Naranjo probability scale suggested a possible association between intrathecal vancomycin and the observed hearing loss.

    • Implications:

    • Healthcare providers should be aware of the potential for ototoxicity with intrathecal vancomycin.
    • Vigilant audiometric monitoring is recommended for patients receiving intrathecal vancomycin.
    • Further research is needed to elucidate the mechanisms and incidence of vancomycin-induced ototoxicity via the intrathecal route.