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Ototoxicity of amikacin
Abstract:
Amikacin was used in 77 treatment courses at a dosage of >/=7.5 mg/kg every 8 h, and patients were monitored for ototoxicity by following serial audiograms, serum creatinine, and amikacin blood levels. Patients were leukopenic (58), were infected by gentamicin-resistant organisms (11), or had cystic fibrosis (8). Three patients developed tinnitus, but none had vertigo or nystagmus. Of 55 courses with pre- and post-treatment audiogram, 13 (24%) were associated with development of high-frequency hearing loss, which was usually bilateral. No patient had conversational hearing loss, and audiograms reverted to normal in three patients. Onset of cochlear damage occurred in one patient after therapy was stopped. The group with high-tone hearing loss, in comparison to the group without audiographic changes, received a larger mean total dose (24 versus 9.6 g), were treated for a longer duration (19 versus 9 days), and more frequently had previous aminoglycosides. Fifty-seven percent of patients with a "peak" serum level exceeding 32 mug/ml and 55% of patients with "trough" levels exceeding 10 mug/ml developed cochlear damage. There was no difference between the groups in age, body weight, previous cochlear damage, renal disease before or during therapy, or average daily dose. Both monitoring of blood levels and limiting duration of therapy may prevent amikacin ototoxicity.
Insights
Amikacin ototoxicity can cause high-frequency hearing loss, particularly with higher doses and longer treatment durations. Monitoring amikacin blood levels and limiting therapy duration may prevent hearing damage.
Area of Science:
- Pharmacology
- Ototoxicology
- Nephrology
Background:
- Amikacin is an aminoglycoside antibiotic used for severe infections.
- Aminoglycosides are known for potential ototoxicity and nephrotoxicity.
- Monitoring is crucial to mitigate adverse effects.
Purpose of the Study:
- To evaluate the incidence and risk factors of amikacin-induced ototoxicity.
- To assess the effectiveness of monitoring strategies for ototoxicity.
Main Methods:
- Prospective study of 77 patients receiving amikacin.
- Monitoring included serial audiograms, serum creatinine, and amikacin blood levels.
- Analysis of risk factors such as dose, duration, and previous aminoglycoside exposure.
Main Results:
- 24% of patients developed high-frequency hearing loss.
- Higher total dose, longer duration, and prior aminoglycoside use were associated with hearing loss.
- High peak (>32 µg/ml) and trough (>10 µg/ml) amikacin levels correlated with cochlear damage.
Conclusions:
- Amikacin ototoxicity, manifesting as high-frequency hearing loss, is a significant concern.
- Monitoring blood levels and limiting treatment duration are key preventive strategies.
- Early detection and intervention can potentially reduce hearing damage.