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Gentamicin vestibulotoxicity

G M Halmagyi¹, C M Fattore, I S Curthoys

¹Neuro-otology Department, Royal Prince Alfred Hospital, Sydney, Australia.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|November 1, 1994

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Gentamicin can harm the vestibular system, even at recommended doses. Early recognition of vestibulotoxicity symptoms is crucial to prevent permanent damage, especially when kidney toxicity is present.

Area of Science:

Ototoxicity
Nephrology
Clinical Pharmacology

Background:

Gentamicin is a widely used antibiotic.
Vestibulotoxicity and nephrotoxicity are known adverse effects of gentamicin.
The relationship between gentamicin dosage, serum levels, and these toxicities requires further clarification.

Purpose of the Study:

To investigate the relationship between gentamicin dosage, serum levels, and the development of vestibulotoxicity and nephrotoxicity.
To assess the clinical recognition of gentamicin vestibulotoxicity.

Main Methods:

Retrospective review of 36 patients treated with gentamicin.
Analysis of gentamicin dosage, serum levels, and concurrent development of vestibulotoxicity and nephrotoxicity.

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Main Results:

Gentamicin vestibulotoxicity occurred in patients receiving both standard and reduced doses/durations.
Nephrotoxicity developed in 16 of 30 patients receiving intravenous or intramuscular gentamicin.
Vestibulotoxicity was often unrecognized before hospital discharge (32/36 patients).
An increased risk of vestibulotoxicity was observed in patients with nephrotoxicity.

Conclusions:

There is no definitively safe dose or serum level of gentamicin to prevent vestibular damage.
Nephrotoxicity is associated with an increased risk of vestibulotoxicity.
Increased physician awareness of vestibulotoxicity clinical features is essential for early intervention and prevention of permanent vestibular impairment.