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Ototoxicity and nephrotoxicity of gentamicin vs netilmicin in patients with serious infections. A randomized clinical
R A Tange1, W A Dreschler, J M Prins
1Department of Otorhinolaryngology, Internal Medicine, Unit for Infectious Diseases and Tropical Medicine and Medical, Academic Medical Centre, Amsterdam, The Netherlands.
Abstract:
In the treatment of serious infection by aminoglycoside antibiotics multiple daily treatment with netilmicin is considered to be the least toxic. Studies comparing netilmicin with gentamicin using the less toxic once-daily schedule are lacking. A randomized prospective study was designed to evaluate the efficacy and toxicity of once-daily netilmicin with gentamicin treatment in patients with serious infections. Consecutive patients with serious infections were randomized between gentamicin 4 mg/kg q24h iv or netilmicin 5.5 mg/kg q24h iv. Exclusion criteria were neutropenia or severe renal failure. A good clinical response was observed in 50 of the 54 evaluable patients (92.6%) treated with gentamicin and in 48/52 (92.3%) netilmicin treated patients. Nephrotoxicity developed in 5/72 (6.9%) gentamicin patients and in 10/69 (14.5%) treated with netilmicin. Audiometry was performed with high-frequency audiometry when possible; no significant differences were found between the two aminoglycosides. We conclude that with once-daily treatment no benefit of netilmicin over gentamicin regarding nephro- or ototoxicity could be demonstrated.
Insights
Once-daily netilmicin and gentamicin show similar efficacy for serious infections. However, netilmicin demonstrated a higher rate of nephrotoxicity compared to gentamicin in this once-daily aminoglycoside antibiotic study.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Aminoglycoside antibiotics are crucial for treating serious infections.
- Netilmicin is often considered less toxic than gentamicin with multiple daily doses.
- Limited data exists comparing once-daily netilmicin and gentamicin toxicity.
Purpose of the Study:
- To evaluate the efficacy and toxicity of once-daily netilmicin versus gentamicin.
- To compare nephrotoxicity and ototoxicity between the two aminoglycosides in a once-daily regimen.
Main Methods:
- A randomized prospective study included patients with serious infections.
- Patients received either gentamicin (4 mg/kg q24h IV) or netilmicin (5.5 mg/kg q24h IV).
- Exclusion criteria included neutropenia and severe renal failure; clinical response, nephrotoxicity, and audiometry were assessed.
Main Results:
- Good clinical response rates were high and similar for both groups (92.6% gentamicin vs. 92.3% netilmicin).
- Nephrotoxicity occurred in 6.9% of gentamicin patients and 14.5% of netilmicin patients.
- No significant differences in ototoxicity were detected between the two treatment groups.
Conclusions:
- Once-daily administration of netilmicin offers no demonstrable advantage over gentamicin in terms of nephrotoxicity or ototoxicity.
- Both aminoglycosides exhibit comparable clinical efficacy when administered once daily for serious infections.
- Further research may be needed to fully elucidate the long-term safety profiles of once-daily netilmicin and gentamicin.