title: Long term streptomycin toxicity in the treatment of Buruli Ulcer: follow-up of participants in the BURULICO drug trial.
abstract: BACKGROUND
  Buruli Ulcer (BU) is a tropical infectious skin disease that is currently treated with 8 weeks of intramuscular streptomycin and oral rifampicin. As prolonged streptomycin administration can cause both oto- and nephrotoxicity, we evaluated its long term toxicity by following-up former BU patients that had received either 4 or 8 weeks of streptomycin in addition to other drugs between 2006 and 2008, in the context of a randomized controlled trial.
  
  
  METHODS
  Former patients were retrieved in 2012, and oto- and nephrotoxicity were determined by audiometry and serum creatinine levels. Data were compared with baseline and week 8 measurements during the drug trial.
  
  
  RESULTS
  Of the total of 151 former patients, 127 (84%) were retrieved. Ototoxicity was present in 29% of adults and 25% of children. Adults in the 8 week streptomycin group had significantly higher hearing thresholds in all frequencies at long term follow-up, and these differences were most prominent in the high frequencies. In children, no differences between the two treatment arms were found. Nephrotoxicity that had been detected in 14% of adults and in 13% of children during treatment, was present in only 2.4% of patients at long term follow-up.
  
  
  CONCLUSIONS
  Prolonged streptomycin administration in the adult study subjects caused significant persistent hearing loss, especially in the high frequency range. Nephrotoxicity was also present in both adults and children but appeared to be transient. Streptomycin should be given with caution especially in patients aged 16 or older, and in individuals with concurrent risks for renal dysfunction or hearing loss.
authors.affiliation: Department of Internal Medicine, Infectious Disease Service, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Sandor
authors.initials: S
authors.lastname: Klis
authors.affiliation: Department of Internal Medicine, Infectious Disease Service, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Phillips
authors.affiliation: Agogo Presbyterian Hospital, Agogo, Ghana.
authors.forename: Kabiru Mohammed
authors.initials: KM
authors.lastname: Abass
authors.affiliation: Nkawie-Toase Government Hospital, Nkawie, Ghana.
authors.forename: Wilson
authors.initials: W
authors.lastname: Tuah
authors.affiliation: Department of Internal Medicine, Infectious Disease Service, University Medical Center Groningen, Groningen, the Netherlands; Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001299:Audiometry; D054312:Buruli Ulcer / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D034381:Hearing Loss / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013307:Streptomycin / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003404:Creatinine; D013307:Streptomycin