Gentamicin Vestibulotoxicity: Further Insights From a Large Clinical Series
| Autor: | John Rutka, Terence S Fu, Ophir Ilan, Wanda Dillon, David D. Pothier, Simon D. Carr, Jerome A. Leis, Wayne L. Gold, Iqbal Mohammed Syed, Paul Douglas-Jones |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Vestibular evoked myogenic potential Nephrotoxicity Neurotology 03 medical and health sciences 0302 clinical medicine medicine Humans Videonystagmography Dosing Saccule and Utricle 030223 otorhinolaryngology Retrospective Studies medicine.diagnostic_test Cumulative dose business.industry Osteomyelitis medicine.disease Vestibular Evoked Myogenic Potentials Semicircular Canals Sensory Systems Otorhinolaryngology Anesthesia Gentamicin Neurology (clinical) Gentamicins business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Otology & Neurotology. 41:e864-e872 |
| ISSN: | 1537-4505 1531-7129 |
| DOI: | 10.1097/mao.0000000000002698 |
| Popis: | OBJECTIVE To review insights gained from a 21-year experience with gentamicin-induced vestibulotoxicity including differences in vestibulotoxicity between single daily dosing (SDD) and multiple daily dosing (MDD) regimens. STUDY DESIGN Retrospective case series. SETTING Tertiary care center. PATIENTS Patients with gentamicin vestibulotoxicity referred to the Hertz Multidisciplinary Neurotology Clinic between January 1993 and September 2014. INTERVENTION None. MAIN OUTCOME MEASURES Spectrum of vestibular dysfunction measured using videonystagmography, vestibular evoked myogenic potentials, video head impulse testing, and magnetic scleral search coil testing. RESULTS Of 53 patients with gentamicin-induced vestibulotoxicity, 24 received SDD and 29 received MDD treatment. The most common indications for treatment were sepsis, endocarditis, and osteomyelitis. Angular acceleration receptor function (semicircular canals) was more commonly affected than linear acceleration receptor function (otolithic organ of the saccule; 100% vs. 62%). A significant proportion of patients (53%) developed vestibulotoxicity in the absence of nephrotoxicity and 40% experienced vestibulotoxicity in a delayed fashion up to 10 days posttreatment cessation (mean 3.9 ± 0.7). Therapeutic monitoring did not necessarily prevent delayed vestibulotoxicity. Nephrotoxicity was less common for SDD compared with MDD (60% vs. 35%, p = 0.01). However, the SDD group experienced vestibulotoxicity at a lower cumulative dose (6.3 vs. 7.0 g, p = 0.04) and shorter duration of therapy (20.7 vs 29.4 d, p = 0.02). CONCLUSIONS Our study further highlights important insights regarding gentamicin-induced vestibulotoxicity. While SDD is associated with decreased risk for nephrotoxicity compared with MDD, it confers a higher risk for vestibulotoxicity. |
| Databáze: | OpenAIRE |
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