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Vestibulotoxicity in a patient without renal failure after inhaled tobramycin
Adam C Kaufman1, Steven J Eliades1
1Hospital of the University of Pennsylvania, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, PA, USA.
Abstract:
Aminoglycoside antibiotics have a long history of use in the control of gram-negative bacterial infections, but their systemic use has been complicated by known ototoxicity and nephrotoxicity. Because of the utility of these medications in patients with frequent pulmonary infections, there has been a move towards the use of inhaled agents, in particular tobramycin, due to a lower rate of systemic complications. Inhaled tobramycin is generally consider to be safe from otologic complications, with only two previous reports of ototoxicity, both in patients who had underlying chronic renal disease. Here we present the first case of a patient developing isolated vestibular toxicity, without associated hearing loss or evidence of renal insufficiency, in a patient receiving inhaled tobramycin. This is an extremely rare complication of an inhaled aminoglycoside and underscores the importance of careful monitoring despite perceived safety.
Insights
Inhaled tobramycin is generally safe for lung infections, but this report details a rare case of isolated vestibular toxicity without hearing or kidney damage. Careful monitoring is crucial even with perceived safety.
Area of Science:
- Pharmacology
- Ototoxicology
- Infectious Diseases
Background:
- Aminoglycoside antibiotics are vital for Gram-negative bacterial infections.
- Systemic use is limited by ototoxicity and nephrotoxicity.
- Inhaled tobramycin offers a safer alternative for pulmonary infections, reducing systemic risks.
Observation:
- A patient receiving inhaled tobramycin developed isolated vestibular toxicity.
- This occurred without concurrent hearing loss or renal insufficiency.
- This is the first reported case of its kind.
Findings:
- Inhaled tobramycin can cause isolated vestibular toxicity, a rare complication.
- Ototoxicity may occur even without underlying renal disease.
- The safety profile of inhaled tobramycin requires careful consideration.
Implications:
- Highlights the need for vigilant monitoring of inhaled aminoglycosides.
- Suggests potential for otologic side effects beyond previously recognized risks.
- Underscores the importance of individualized patient assessment for inhaled antibiotic therapy.
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