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Ototoxicity of gentamicin: clinical experience in a children's hospital
Insights
Gentamicin ototoxicity in children can cause hearing loss. Risk factors include kidney problems, diuretic use, and high peak serum concentrations, with a minimum incidence of 2.4% for overt hearing loss.
Area of Science:
- Pediatric Pharmacology
- Ototoxicology
- Clinical Audiology
Background:
- Gentamicin is a widely used antibiotic in pediatric care.
- Ototoxicity is a known adverse effect of aminoglycoside antibiotics like gentamicin.
- Estimating the incidence of gentamicin-induced ototoxicity in children is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of clinical ototoxicity in children receiving gentamicin.
- To identify risk factors associated with gentamicin-induced hearing loss in pediatric patients.
Main Methods:
- Retrospective chart review of 374 pediatric patients with serum gentamicin levels.
- Analysis of audiograms from 37 patients (9-17 years) with at least two tests.
- Correlation of hearing loss with renal function, diuretic use, and peak gentamicin serum concentrations.
Main Results:
- Nine out of 37 pediatric patients (24.3%) developed objective hearing loss.
- Two patients experienced severe and permanent hearing impairment.
- Significant risk factors for ototoxicity included renal failure, concurrent diuretic use, and peak serum gentamicin concentrations > 12 mcg/ml (p < 0.01).
- The minimum incidence of overt hearing loss was 2.4%.
Conclusions:
- Gentamicin therapy is associated with a clinically significant incidence of ototoxicity in children.
- Close monitoring of serum gentamicin levels, renal function, and concomitant medications is essential to mitigate ototoxicity risk.
- Pediatric patients with risk factors require careful audiological surveillance during and after gentamicin treatment.
Abstract:
In a effort to estimate the incidence of clinical ototoxicity in children we reviewed the charts of 374 patients who had serum gentamicin concentration determined 30 min before ('trough value') and at the pharmacologic peak after parenteral administration. 37 of these patients, between 9 and 17 years of age, had two or more audiograms; of these, 9 developed objective evidence of hearing loss; in 2 the impairment was severe and permanent. Risk factors associated with ototoxicity were renal failure, concomitant administration of diuretics and peak serum concentrations greater than 12 microgram/ml (all significant at p less than 0.01). The minimum incidence of overt hearing loss secondary to gentamicin therapy is approximately 2.4%.