Erythromycin-Induced Ototoxicity: Case Report

Abstract

Objective: To report a case of erythromycin-induced ototoxicity and to discuss the occurrence of this event. Case Summary: A 26-year-old woman was admitted to the medical intensive care unit with a two-day history of progressive shortness of breath, high-grade fever, cough, and pleuritic chest pain. Arterial blood gases on room air showed severe hypoxemia, and a chest X-ray revealed right lower-lobe infiltrates. Provisional diagnosis was atypical pneumonia, for which erythromycin lactobionate 1 g q6h iv was administered. All other chronic medications were maintained at the same dosage and frequency. All laboratory work remained stable. After 36 hours, the patient developed sensorineural hearing loss. Erythromycin was stopped immediately. After 24 hours, there was subjective improvement of hearing, with complete return to pretreatment levels in 72 hours. Discussion: A review of the literature showed only 40 reported cases of reversible ototoxicity, mainly with high dosages of erythromycin (4 g/d). Conclusions: High-dose erythromycin therapy can cause reversible sensorineural hearing impairment. Treatment with erythromycin 4 g/d should be reserved for immunosuppressed patients with Legionnaires' disease and patients with Legionella endocarditis. Patients should have a baseline audiogram and regular monitoring for subjective evidence of sensorineural hearing loss, and the drug should be discontinued if ototoxicity is suspected.

Macrolide‐associated sensorineural hearing loss: A systematic review

“…There were 24 publications (n = 45 cases) that reported intravenous erythromycin‐associated SNHL. The standard intravenous dose exposure of 4 grams per day was given in 16 studies (n = 32 cases) . A higher dose exposure of 6 grams per day was described in two patients .…”

“…In 27 reversible cases, SNHL was sudden and bilateral (Appendix 3; available online) . High‐frequency hearing loss was specifically reported in eight studies (n = 12 patients) . SNHL at all frequencies was specified in seven studies (n = 12 patients) .…”

“…The standard intravenous dose exposure of 4 grams per day was given in 16 studies (n 5 32 cases). 14,15,24,[35][36][37][38][39][40][41][42][43][44][45][46][47] A higher dose exposure of 6 grams per day was described in two patients. 48,49 Six studies included patients who received less than 4 grams per day.…”

“…24,29,30,34,35,[38][39][40][41][42][43][46][47][48][49][51][52][53][54][55][56][57][58][59][60][61] High-frequency hearing loss was specifically reported in eight studies (n 5 12 patients). 24,33,38,42,46,51,55,61 SNHL at all frequencies was specified in seven studies (n 5 12 patients). 34,35,39,43,47,54,59,60 The remaining publications did not describe the affected frequencies.…”

“…63 Recovery times, however, were as long as 4 months. 52 For intravenous erythromycin, subjectively hearing improvements were reported at 12 hours postcessation 40 and complete reversal as early as 72 hours 42 ; the longest time to improvement was in a case followed for 21 days due to continued use of lower dose erythromycin. 36 Reversible With Cessation of Macrolide and Steroid Intervention.…”