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Abstract:
The author participated in two prospective studies of patients receiving aminoglycoside antibiotics. In the first study, 54 patients received amikacin, and 54 received gentamicin. In the second study, 61 patients received gentamicin, 50 received netilmicin, and 52 received tobramycin. The studies were randomized and the investigator was blinded when evaluating auditory and vestibular toxicity and nephrotoxicity. All patients had pure tone audiometric evaluations, and two thirds of the patients had vestibular function tests consisting of an electronystagmogram performed with 30 degrees C and 44 degrees C water. Nephrotoxicity was measured by changes in serum creatinine levels. The incidence of gentamicin toxicity in the first study was 11 per cent, and it was 18 per cent in the second study. Amikacin was ototoxic 12.9 per cent of the time, whereas the incidence of tobramycin ototoxicity was 11.5 per cent, and the incidence of netilmicin ototoxicity was 2 per cent. Cases of unilateral, delayed-onset, and reversible auditory and vestibular toxicities were seen in all drug treatment groups. Nephrotoxicity was rare with amikacin usage. Gentamicin, on the other hand, produced a 18.6 per cent, tobramycin a 25 per cent, and netilmicin a 21.3 per cent rate of nephrotoxicity.
Insights
Aminoglycoside antibiotics like gentamicin and tobramycin show varying toxicity rates. Netilmicin demonstrated the lowest ototoxicity (2%), while amikacin had rare nephrotoxicity, unlike other agents.
Area of Science:
- Pharmacology and Toxicology
- Nephrology
- Ototoxicology
Background:
- Aminoglycoside antibiotics are crucial for treating severe bacterial infections.
- Potential toxicities, including ototoxicity and nephrotoxicity, necessitate careful monitoring.
- Comparative data on the safety profiles of different aminoglycosides is essential for clinical decision-making.
Purpose of the Study:
- To prospectively compare the auditory, vestibular, and renal toxicities of commonly used aminoglycoside antibiotics.
- To evaluate the incidence and characteristics of ototoxicity and nephrotoxicity associated with amikacin, gentamicin, netilmicin, and tobramycin.
Main Methods:
- Two randomized, blinded prospective studies involving patients receiving aminoglycoside antibiotics.
- Auditory toxicity assessed via pure tone audiometry.
- Vestibular toxicity evaluated using electronystagmography (30°C and 44°C water).
- Nephrotoxicity monitored by changes in serum creatinine levels.
Main Results:
- Gentamicin showed toxicity rates of 11% and 18% in the two studies.
- Ototoxicity incidences: Amikacin (12.9%), Tobramycin (11.5%), Netilmicin (2%).
- Nephrotoxicity rates: Gentamicin (18.6%), Tobramycin (25%), Netilmicin (21.3%). Amikacin exhibited rare nephrotoxicity.
- Auditory and vestibular toxicities were unilateral, delayed-onset, and reversible across all groups.
Conclusions:
- Netilmicin appears to have a significantly lower ototoxicity profile compared to other aminoglycosides studied.
- Amikacin demonstrates a favorable safety profile regarding nephrotoxicity.
- All studied aminoglycosides carry risks of auditory and vestibular toxicity, emphasizing the need for vigilant patient monitoring.