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 μg/ml and 55% of patients with “trough” levels exceeding 10 μg/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.

Live CT imaging of sound reception anatomy and hearing measurements in the pygmy killer whale, Feresa attenuata

“…From 14 to 22 July 2008 and from 5 to 24 September 2008, MML0802 received a dose of 21mgkg -1 amikacin sulfate intramuscularly every other day. In humans, the aminoglycoside antibiotic amikacin has been shown to be ototoxic (Black et al, 1976). Amikacin has also been implicated in hearing loss of a beluga whale, where this antibiotic was used to treat a Nocardia spp.…”

“…In clinical studies with humans that exhibited hearing impairments caused by amikacin therapy, hearing loss occurred most frequently at higher frequencies (Black et al, 1976). In a beluga whale that showed deficits in auditory sensitivity associated with amikacin treatment, hearing loss also occurred at higher frequencies (Finneran et al, 2005).…”

Clinical Pharmacokinetics, Toxicity and Cost Effectiveness Analysis of Aminoglycosides and Aminoglycoside Dosing Services

“…Using audiometry, a decrease of greater than 10 dB was accepted by Smith et al (60), while Black et al, required a 15 dB-20 dB decrease at frequencies between 0.25 and 8-0 kHz (74). Netilmicin appears to be the least cochleo-and vestibulotoxic.…”

Comparison of the nephrotoxicity and auditory toxicity of tobramycin and amikacin

“…The patients in groups evaluated for either nephrotoxicity or auditory toxicity were similar with respect to intensity and etiology of bacterial disease, concurrent exposure to other antimicrobial drugs, a,ge and sex distribution, initial serum creatinine level, and total dose and duration of antimicrobial therapy. Nephrotoxicity of similar severity developed in 4 of 59 (6.8%) recipients of tobramycin and in 7 of 54 (13.1%o) recipients of amikacin (P > 0.05). Mild auditory toxicity developed in 3 of 19 (15.7%) recipients of tobramycin and in 2 of 17 (11.7%) recipients of amikacin (P > 0.05).…”