title: Ototoxicity and nephrotoxicity of gentamicin vs netilmicin in patients with serious infections. A randomized clinical trial.
abstract: 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.
authors.affiliation: Department of Otorhinolaryngology, Internal Medicine, Unit for Infectious Diseases and Tropical Medicine and Medical, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Tange
authors.forename: W A
authors.initials: WA
authors.lastname: Dreschler
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.forename: H R
authors.initials: HR
authors.lastname: Büller
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: P
authors.initials: P
authors.lastname: Speelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D003404:Creatinine / Q000097:blood* / Q000652:urine*; D005260:Female; D005839:Gentamicins / Q000009:adverse effects* / Q000627:therapeutic use*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007239:Infections / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005839:Gentamicins; D009428:Netilmicin; D003404:Creatinine