The cumulative effects of intravenous antibiotic treatments on hearing in patients with cystic fibrosis

• Published in: Journal of cystic fibrosis Vol. 16; no. 3; pp. 401 - 409
• Main Authors: Garinis, Angela C, Cross, Campbell P, Srikanth, Priya, Carroll, Kelly, Feeney, M. Patrick, Keefe, Douglas H, Hunter, Lisa L, Putterman, Daniel B, Cohen, David M, Gold, Jeffrey A, Steyger, Peter S
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2017
• Subjects: Adolescent; Adult; Age Factors; Amikacin - administration & dosage; Amikacin - adverse effects; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Audiometry, Pure-Tone - methods; Bacterial Infections - drug therapy; Bacterial Infections - etiology; Cystic Fibrosis - complications; Cystic Fibrosis - drug therapy; Cystic Fibrosis - epidemiology; Female; Hearing Loss - chemically induced; Hearing Loss - diagnosis; Hearing Loss - epidemiology; Hearing Loss - prevention & control; Humans; Male; Middle Aged; Patient Outcome Assessment; Pulmonary/Respiratory; Sex Factors; Time; Tobramycin - administration & dosage; Tobramycin - adverse effects; United States - epidemiology; Vancomycin - administration & dosage; Vancomycin - adverse effects
• ISSN: 1569-1993; 1873-5010
• DOI: 10.1016/j.jcf.2017.01.006

Abstract Background Aminoglycosides (AGs) and glycopeptides are antibiotics essential for treating life-threatening respiratory infections in patients with cystic fibrosis (CF). The goal of this study was to examine the effects of cumulative intravenous (IV)-AG (amikacin and/or tobramycin) and/or glycopeptide (vancomycin) dosing on hearing status in patients with CF. Methods Hearing thresholds were measured from 0.25 to 16.0 kHz, in 81 participants with CF. Participants were categorized into two groups: normal hearing in both ears (≤ 25 dB HL for all frequency bands) or hearing loss (> 25 dB HL for any frequency band in either ear). Participants were also characterized into quartiles by their cumulative IV-AG (with or without vancomycin) exposure. Dosing was calculated using two strategies: (i) total number of lifetime doses, and (ii) total number of lifetime doses while accounting for the total doses per day. This was referred to as the “weighted” method. Results Participants in the hearing loss group were significantly older than those in the normal-hearing group. After adjusting for gender and age at the time of hearing test, participants in the two highest-quartile exposure groups were almost 5 X more likely to have permanent sensorineural hearing loss than those in the two lowest-quartile exposure groups. There was a small group of CF patients who had normal hearing despite high exposure to IV-antibiotics. Conclusions Cumulative IV-antibiotic dosing has a significant negative effect on hearing sensitivity in patients with CF, when controlling for age and gender effects. A trend for increasing odds of hearing loss was associated with increasing cumulative IV-antibiotic dosing.