Side effects of aminoglycosides on the kidney, ear and balance in cystic fibrosis

Abstract

Aminoglycoside antibiotics are a central component of the treatment of pulmonary exacerbations of cystic fibrosis (CF) and slow the decline in lung function which ultimately causes the death of most patients. The prognosis of CF has improved, and thus side effects of treatments have become increasingly important. Observational studies suggest that the morbidity from side effects of aminoglycosides is disturbingly common, and that aggressive treatment may lead to more side effects. This review of the current literature on side effects of aminoglycosides considers the pathophysiological mechanisms, epidemiology and risk factors, investigation of side effects and preventative strategies. Treatments which have shown early promise are identified and areas of future research are discussed.

Anti-Pseudomonas aeruginosaIgY antibodies promote bacterial opsonization and augment the phagocytic activity of polymorphonuclear neutrophils

“…8 However, failure of early eradication is observed in nearly 20% of cases. 9 Although AET does not promote antimicrobial resistance, 10 the subsequent aggressive chronic suppressive therapy is accompanied by the emergence of resistant bacteria 11,12,13 and antibiotic-associated adverse effects 14,15 and generally constitutes a substantive treatment burden for patients. Consequently, it would be favorable to complement antibiotics with other therapies to reduce colonization of P. aeruginosa in the airways of CF patients.…”

Diagnosis and Treatment of Abnormal Vaginal Discharge

“…Например, канамицин не действует на анаэробные микроорганизмы, дрожжевые грибы и простей-ших, обладает ото-и нефротоксическим эффектом, к нему быстро развивается резистентность [35][36][37], в России не зарегистрированы вагинальные формы [35]. Клиндамицин неэф фективен в отношении Enterococcus faecalis [38], для лечения аэробного вагинита необходим его очень длитель-ный прием (4-6 недель), поскольку отмечены высокие уров-ни резистентности среди C. difficile (70%), B. fragilis (30-40%), Prevotella spp.…”

Investigating the host and bacterial factors in cystic fibrosis that promote persistence of infection in the lung

“…of outpatient visits* 5 (3-9) 7 (4-10) Participants, n (% of total clinic population) 36 (64) 15 (30) 20 (35) (19)(20)(21)(22)(23)(24) No. of outpatient visits* 4 (3-6) 4 (3-9) 9 (4-12) 4 (2)(3)(4)(5)(6) No. of IV antibiotic courses*…”

“…Furthermore, the results indicate (especially among paediatric centres) that treatment practices may influence the development of MARPA. Although the clinical significance of MARPA remains a matter of debate (238,239), increased antibiotic usage at an early age may impact on long term treatment related morbidity, including the development of antibiotic allergy and toxicity (5,6,351). Despite the variable treatment approaches employed, there were few differences in health related outcomes between centres, however, longitudinal studies will be important in determining whether the early benefits of aggressive antibiotic treatment in early life are sustained into adulthood.…”

“…changing the antibiotics prescribed during the treatment of a pulmonary exacerbation. However, such treatment strategies will require careful investigation, in particular for the occurrence of adverse effects, including the potential for increased rates of antibiotic allergy and toxicity, and development of MARPA (5,6,235,351). Furthermore, if clinical improvements cannot be attributed to changes in the lung microbiome, the clinical beneficial effects of adjuvant therapies administered alongside antibiotics, including airway clearance techniques, use of mucolytics, rehydration and nutritional supplementation, merit greater consideration in future studies.…”