Clinical predictors of aminoglycoside-induced ototoxicity in drug-resistant Tuberculosis patients on intensive therapy.
OBJECTIVE
The study objectives were to determine the incidence of aminoglycoside-induced ototoxicity in institutionalized patients on intensive phase of therapy for drug-resistant Tuberculosis (DR Tb) and also to assess clinical factors which could predict the ototoxicity.


METHODS
The study was a prospective analytical study among consecutive DR Tb patients who were admitted for intensive phase of therapy (of 4 months) at the DR-Tb center over a 12-month period. Patients were diagnosed as DR Tb using the Gene Xpert machine to confirm Rifampicin resistance. All eligible 70 out of 87 consenting patients were consecutively recruited into the study. Patients had baseline (admission) and serial pure tone audiometries (PTAs) performed at 4 weekly intervals until discharge after 4 months of admission. Audiometric confirmation of aminoglycoside-induced ototoxicity was done by comparing serial with baseline PTA.


RESULTS
Among the 70 patients the male:female ratio was 1.7:1. Nine patients (12.9%) were retroviral-positive, and 16 patients (22.9%) were confirmed to have ototoxicity by audiometric criteria. The duration of treatment when ototoxicity was detected in the patients ranged 4-17 (Mean±SD; 9.4±3.4) weeks. Ototoxicity was detected in the audiometric low frequency ranges in 7 (43.8%) and at the high frequencies in 4 (25.0%) of the patients. Univariate analyses of clinical parameters found that age, underlying diabetes mellitus, deranged baseline PTAv >25dB HL, BMI on admission and retroviral status were significantly associated, while sex and previous drug regimen failure were not associated with ototoxicity. Multivariate adjusted logistic regression analyses, controlling for sex, revealed age (OR=1.068, p=0.018), BMI on admission (OR=0.673, p=0.012) and retroviral positivity (OR=8.822, p=0.014) of patients could significantly predict aminoglycoside-induced ototoxicity.


CONCLUSIONS
Incidence of aminoglycoside-induced ototoxicity in DR Tb patients was 22.9%. The clinical predictors for ototoxicity were age, BMI on admission, and co-existing retroviral infection in the patients. Clinicians should consider these factors in making choices of aminoglycosides to be used during intensive phase of treatment with second line anti-Tuberculous therapy.
ENT Unit, Department of Surgery, Faculty of Clinical Sciences, Olabisi Onabanjo University, Sagamu, Nigeria. Electronic address: ayosogebi2000@yahoo.com.
Olusola Ayodele
OA
Sogebi
Department of Medicine, Faculty of Clinical Sciences, Olabisi Onabanjo University, Sagamu, Nigeria.
Bolanle Olufunlola
BO
Adefuye
Department of Otorhinolaryngology, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria.
Stephen Oluwatosin
SO
Adebola
ENT Unit, Department of Surgery, Babcock University Teaching Hospital, Ilishan, Nigeria.
Susan Modupe
SM
Oladeji
Department of Otorhinolaryngology, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria.
Taiwo Olugbemiga
TO
Adedeji
D000328:Adult; D000367:Age Factors; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D015992:Body Mass Index; D060085:Coinfection; D015897:Comorbidity; D003523:Cycloserine / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D034381:Hearing Loss / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007612:Kanamycin / Q000008:administration & dosage / Q000009:adverse effects*; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011446:Prospective Studies; D011515:Prothionamide / Q000627:therapeutic use; D011718:Pyrazinamide / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D055815:Young Adult
D000617:Aminoglycosides; D000995:Antitubercular Agents; D011718:Pyrazinamide; D007612:Kanamycin; D064704:Levofloxacin; D011515:Prothionamide; D003523:Cycloserine
Aminoglycosides; Audiometry; Drug-resistant Tuberculosis; Ototoxicity; Predictors