Vestibular toxicity of gentamicin. Incidence in patients receiving long-term hemodialysis therapy

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Abstract
Twenty-three patients on long-term hemodialysis regimens who received gentamicin sulfate were reviewed retrospectively to assess the incidence of ototoxicity and to identify potential risk factors. Dosage of gentamicin sulfate was 1.0-1.5 mg/kg i.v. 3 times weekly. Serum gentamicin levels were monitored in 21 cases. Seven patients developed signs and symptoms of vestibular dysfunction. Statistically significant differences were found between the ototoxic and nonototoxic groups with respect to age (P < .001), total dose (milligrams/kilogram) (P < .001) and duration of therapy (P < .001). The total dose/kilogram of body weight contributed most heavily to ototoxicity and regression analysis suggested that the critical cumulative dose is about 17.5 mg/kg. The 2 groups did not differ with respect to mean peak and valley serum levels. This population is apparently at high risk of developing gentamicin-related vestibular dysfunction specifically when the cumulative dose exceeds 17.5 mg/kg.

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