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Comparative auditory toxicity of aminoglycoside antibiotics in leukopenic patients
Abstract:
The incidence of auditory toxicity resulting from therapy with ticarcillin (T) (12 g/sq m/day) in combination with gentamicin (G) (200 mg/sq m/day), amikacin (A) (600 mg/dq m/day), or netilmicin (N) (280 mg/sq m/day) was compared. Before administration of these antibiotic combinations to febrile, granulocytopenic patients, baseline audiograms were determined by a pharmacist using a portable audiometer. The before-therapy audiograms for 32 patients receiving T and G, 29 receiving T and A, and 29 receiving T and N were compared with the audiograms after the completion of therapy. The mean length of therapy was seven days. Two patients (6.2%) receiving T and G, one (3.4%) receiving T and N, and one (3.4%) receiving T and A developed auditory toxicity with bilateral decreases of at least 20 decibels at one or more frequencies. The incidence of auditory toxicity secondary to aminoglycoside exposure was low, and the relative auditory toxicity among the three aminoglycosides appeared to be similar.
Insights
This study compared auditory toxicity from ticarcillin combined with gentamicin, amikacin, or netilmicin in febrile, granulocytopenic patients. The incidence of ototoxicity was low and similar across the three aminoglycoside antibiotic combinations.
Area of Science:
- Pharmacology
- Ototoxicity Research
- Clinical Antibiotic Studies
Background:
- Ticarcillin is frequently used with aminoglycosides to treat infections in immunocompromised patients.
- Aminoglycosides are known for potential nephrotoxicity and ototoxicity.
- Assessing ototoxicity risk is crucial for optimizing treatment regimens in vulnerable populations.
Purpose of the Study:
- To compare the incidence of auditory toxicity associated with ticarcillin in combination with gentamicin, amikacin, or netilmicin.
- To evaluate the relative ototoxic potential of these three aminoglycoside antibiotics when administered concurrently with ticarcillin.
- To inform clinical practice regarding the safety of these antibiotic combinations in febrile, granulocytopenic patients.
Main Methods:
- Prospective comparison of auditory toxicity incidence.
- Baseline audiograms were obtained before therapy initiation.
- Audiograms were reassessed post-therapy completion in patients receiving ticarcillin plus gentamicin, amikacin, or netilmicin.
- Auditory toxicity defined as a bilateral decrease of at least 20 decibels at one or more frequencies.
Main Results:
- The overall incidence of auditory toxicity was low across all treatment groups.
- Two patients (6.2%) receiving ticarcillin and gentamicin developed auditory toxicity.
- One patient (3.4%) each receiving ticarcillin and amikacin, or ticarcillin and netilmicin, experienced auditory toxicity.
- The relative auditory toxicity among gentamicin, amikacin, and netilmicin appeared similar.
Conclusions:
- The combination of ticarcillin with gentamicin, amikacin, or netilmicin demonstrated a low incidence of auditory toxicity.
- The risk of ototoxicity appears comparable among the three tested aminoglycosides when used with ticarcillin.
- These findings suggest that the choice among these specific aminoglycosides may not significantly impact ototoxicity risk in this patient population.