Vestibulotoxicity with systemic Gentamicin in different dosing regimens: our experience in 46 patients

Abstract

Although the use of topical gentamicin has declined systemic gentamicin remains an important antimicrobial agent in the management of infections caused by multidrug-resistant gram-negative bacteria. Nephrotoxicity and Ototoxicity from systemic gentamicin is well documented despite normal gentamicin levels (peak and trough) and normal renal function tests

Nephrotoxicity is a predisposing factor for vestibulotoxicity however vestibulotoxicity can still occur, in patients without nephrotoxicity [19 of 46 (43.1%) % in our series] much more significantly in single daily dosing (SDD) compared to multiple daily dosing (MDD)

From our database of 46 patients we analyzed 19 patients with vestibulotoxicity without nephrotoxicity. Eighteen (94.7%) had imbalance, 10 (52.6%) had oscillopsia, while only 1 (5.3%) and 2 (10.5%) complained of tinnitus and hearing loss

Twelve patients received SDD and 5 MDD. The median cumulative dose resulting in vestibulotoxicity in SDD compared to MDD patients was 4.8g (interquartile range (IQR) = 2.2-8.1g) versus 8.2g (IQR = 6.4-9.4g) (p=0.009) and the median duration of therapy-to-time of diagnosis of vestibulotoxicity was 15d (IQR = 5-22d) versus 34.5d (IQR = 24.3-40.3d) (p=0.03)

In patients without renal dysfunction, gentamicin vestibulotoxicity occurred at a lower cumulative dose and with a shorter duration of therapy in patients who had received SDD versus MDD. Prospective safety evaluation regarding vestibulotoxicity for both dosing regimens is warranted.

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