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Gentamicin-induced ototoxicity complicating treatment of chronic osteomyelitis
Abstract:
Ototoxicity, though a significant disabling complication of aminoglycoside antibiotic therapy, is monitored infrequently. Chronic osteomyelitis patients treated with an aminoglycoside are in a group at higher risk due to the length of therapy and large total dose of drug required for treatment. Serum levels of gentamicin should be maintained within therapeutic ranges but below toxic levels. Gentamicin ototoxicity is vestibular in two thirds of patients and cochlear in one third. One half of the patients with cochlear toxicity also have vestibular symptoms. Symptoms are often vague, insidious in onset, and masked by the critical presentation of the primary infectious process. Symptoms may occur immediately upon initiation of therapy, any time during the course of treatment, or after administration has been completed. The development of toxicity should be monitored on a regular basis by specifically asking the patient whether there has been any subjective hearing loss, ear fullness, tinnitus, or vertigo supplemented by pretreatment and follow-up audiogram and electronystagmogram (ENG). Therapy should be discontinued at the first sign of alteration of cochlear or vestibular function. Ototoxic recovery occurs in only about 50% of the patients affected.
Insights
Aminoglycoside antibiotics can cause ototoxicity, affecting hearing and balance. Monitoring for symptoms like tinnitus or vertigo is crucial, especially in chronic osteomyelitis patients, to prevent permanent damage.
Area of Science:
- Ototoxicity and antibiotic-induced complications.
- Clinical pharmacology of aminoglycosides.
Background:
- Aminoglycoside antibiotics are essential for treating infections like chronic osteomyelitis.
- Ototoxicity is a known but infrequently monitored complication of aminoglycoside therapy.
- Patients with chronic osteomyelitis face higher ototoxicity risk due to prolonged treatment and high cumulative doses.
Observation:
- Ototoxicity from gentamicin affects vestibular function in two-thirds of patients and cochlear function in one-third.
- Symptoms of ototoxicity can be subtle, appear anytime during or after treatment, and may be masked by severe illness.
- Co-occurrence of cochlear and vestibular symptoms is common.
Findings:
- Serum gentamicin levels must be kept within therapeutic but non-toxic ranges.
- Regular monitoring via patient-reported symptoms (hearing loss, tinnitus, vertigo) and audiological tests (audiogram, electronystagmogram) is recommended.
- Early detection of cochlear or vestibular dysfunction necessitates prompt discontinuation of therapy.
Implications:
- Discontinuation of therapy at the first sign of ototoxicity is vital.
- Ototoxic recovery is incomplete, occurring in only about 50% of affected patients.
- Emphasizes the need for vigilant monitoring protocols to mitigate disabling ototoxicity in patients receiving aminoglycosides.