Comparative toxicity of gentamicin versus tobramycin: a randomized prospective study

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Abstract
A prospective randomized study was performed to determine the relative toxicity of gentamicin versus tobramycin in patients treated for proven or suspected Gram-negative bacterial infections. A total of 194 patients completed 4 days or more of aminoglycoside therapy and had adequate evaluation for nephrotoxicity. Ninety-seven patients received gentamicin (102 courses) and 97 tobramycin (103 courses). The characteristics of the two groups including age, underlying disease, pre-existing renal impairment, severity of infection, presence of shock and concomitant treatment with cephalosporins and frusemide were very similar. The total dose, duration and blood levels of aminoglycosides were not significantly different. Possible nephrotoxicity occurred in eight (7·8%) of gentamicin-treated patients and seven (6·8%) of the tobramycin group. Definite nephrotoxicity occurred in 10 (9·8%) of the gentamicin group and eight (7·8%) of the tobramycin group: the difference was not significant. Serial audiological and vestibular studies were completed in only 26 patients (15 on tobramycin and 11 on gentamicin). No significant ototoxicity was seen clinically or by laboratory assessment in any of the patients.

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