OTOTOXICITY OF AMIKACIN
OTOTOXICITY OF AMIKACIN
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DOI：
10.1128/aac.9.6.956
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发表时间：
1976-01-01
影响因子：
4.9
通讯作者：
HEWITT, WL
中科院分区：
文献类型：
--
作者：
BLACK, RE;LAU, WK;HEWITT, WL
阿米卡星以≥7.5 mg/kg/8 h的剂量用于77个疗程，通过连续听力图、血清肌酐和阿米卡星血液水平监测患者的耳毒性。患者为白细胞减少症（58例）、庆大霉素耐药菌感染（11例）或囊性纤维化（8例）。3例患者出现耳鸣，但无眩晕或眼球震颤。在55个疗程的治疗前和治疗后听力图中，13个（24%）与高频听力损失的发展有关，通常是双侧的。没有患者出现对话性听力损失，3例患者的听力图恢复正常。1例患者在停止治疗后发生耳蜗损伤。与听力图无变化的组相比，高音调听力损失组接受的平均总剂量更大（24 g vs 9.6 g），治疗时间更长（19天vs 9天），并且更频繁地使用氨基糖苷类药物。57%的“峰值”血清水平超过32 μg/ml的患者和55%的“谷值”血清水平超过10 μg/ml的患者发生耳蜗损伤。两组之间在年龄、体重、既往耳蜗损伤、治疗前或治疗期间的肾脏疾病或平均每日剂量方面没有差异。监测血药浓度和限制治疗时间都可以预防阿米卡星耳毒性。
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.