netilmicin and Hearing-Loss--Sensorineural

In the treatment of serious infection by aminoglycoside antibiotics multiple daily treatment with netilmicin is considered to be the least toxic. Studies comparing netilmicin with gentamicin using the less toxic once-daily schedule are lacking. A randomized prospective study was designed to evaluate the efficacy and toxicity of once-daily netilmicin with gentamicin treatment in patients with serious infections. Consecutive patients with serious infections were randomized between gentamicin 4 mg/kg q24h iv or netilmicin 5.5 mg/kg q24h iv. Exclusion criteria were neutropenia or severe renal failure. A good clinical response was observed in 50 of the 54 evaluable patients (92.6%) treated with gentamicin and in 48/52 (92.3%) netilmicin treated patients. Nephrotoxicity developed in 5/72 (6.9%) gentamicin patients and in 10/69 (14.5%) treated with netilmicin. Audiometry was performed with high-frequency audiometry when possible; no significant differences were found between the two aminoglycosides. We conclude that with once-daily treatment no benefit of netilmicin over gentamicin regarding nephro- or ototoxicity could be demonstrated.

Topics: Adolescent; Adult; Aged; Audiometry; Creatinine; Female; Gentamicins; Hearing Loss, Sensorineural; Humans; Infections; Male; Middle Aged; Netilmicin; Treatment Outcome

Longitudinal assessment of intensive care nursery infants given aminoglycoside antibiotics revealed no significant difference in the incidence of hearing impairment when compared with age- and sex-matched controls. Bilateral sensorineural impairment was confirmed in three (2%) infants, one each given netilmicin and amikacin and one untreated control infant. There was a high incidence of transient auditory abnormalities in this intensive care infant population. These findings emphasize the importance of long-term follow-up hearing evaluations in infants who require intensive care management in the neonatal period.

Topics: Amikacin; Audiometry, Evoked Response; Bilirubin; Clinical Trials as Topic; Creatinine; Female; Follow-Up Studies; Gentamicins; Hearing Loss, Sensorineural; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kanamycin; Longitudinal Studies; Male; Netilmicin; Prospective Studies

Enterococcal endocarditis can be very difficult to eradicate, requiring prolonged treatment with a combination of a penicillin and an aminoglycoside. In this patient with a pacemaker associated enterococcal endocarditis, ototoxicity occurred due to total gentamicin dose despite plasma concentrations consistently within the treatment range. Substitution with netilmicin, without a break in aminoglycoside treatment, resulted in a rapid improvement in hearing and allowed the required course of aminoglycoside to be completed. The risk factors for ototoxicity with gentamicin are reviewed, in particular the dangers of increasing age and of multiple and prolonged courses. Close treatment monitoring does not totally avoid this risk, especially when prolonged aminoglycoside treatment is required. This case emphasises the need for prompt investigation and adequate, definitive treatment of enterococcal endocarditis to avoid the increased risk consequent on repeated courses of antibiotics. The resolution of the ototoxicity with netilmicin is consistent with other reports of lower cochleotoxicity than with other aminoglycosides.

Topics: Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Equipment Contamination; Gentamicins; Gram-Positive Bacterial Infections; Hearing Loss, Sensorineural; Humans; Male; Netilmicin; Pacemaker, Artificial