Vestibulotoxicity: a risk of home aminoglycoside therapy.
Home intravenous therapy is a cost-effective method of providing prolonged antibiotic therapy. Home infusion of aminoglycosides, however, may produce irreversible vestibular damage. Unfortunately, neither serum levels nor daily dosing precludes vestibulotoxicity. Four patients who developed disabling vestibulotoxicity while being treated at home with aminoglycosides are presented. Details of the original illness, antibiotic therapy, vestibular symptoms, and their outcomes are presented. All patients presented with sudden onset of severe disequilibrium and bilateral vestibular loss confirmed by electronystagmography. None of these patients experienced hearing loss or vertigo. Initial serum levels were normal in three cases. Common misconceptions about aminoglycoside ototoxicity and the inherent risks of home aminoglycoside therapy are discussed. Vestibulotoxicity is difficult to diagnose and there is no safe dose or monitoring schedule. Therefore, aminoglycosides should be avoided if possible. Physicians using aminoglycosides should be aware of the risks involved and patients informed appropriately.
Saunders
James E
JE
University of Oklahoma Health Science Center, Department of Otorhinolaryngology, P.O. Box 26901, WPI360, Oklahoma City, OK 73190-3048, USA.
D000328:Adult; D000617:Aminoglycosides / Q000008:administration & dosage* / Q000009:adverse effects*; D018718:Home Infusion Therapy / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015837:Vestibular Diseases / Q000139:chemically induced*
D000617:Aminoglycosides