Impact of drug-resistant tuberculosis treatment on hearing function in South African adults: Bedaquiline versus kanamycin

Abstract

Background Ototoxicity linked to medications used to treat tuberculosis (TB) remains a global challenge. Objectives The aim was to describe the audiological function in a group of adults with drug-resistant tuberculosis (DR-TB) on bedaquiline (G-BDQ) treatment attending a TB hospital in South Africa and compare this with patients on kanamycin (G-KCIN). Methods A quantitative paradigm was adopted within a non-experimental retrospective record review design. The sample consisted of 30 records of adults with DR-TB between the ages of 18 and 50 years, recruited from a Tropical Diseases Hospital in South Africa. Data were analysed through both descriptive and inferential statistical measures. Results Clear and statistically significant differences in the audiological function were found between the two groups. The group receiving G-KCIN presented with ototoxicity that was clearly demonstrated by sensorineural hearing loss of high-frequency worsening of thresholds in over 73% of the records, which was statistically ( p < 0.05) and clinically significant, over the three testing sessions, demonstrating the cumulative effects of dosage. Increased evidence of tinnitus was also found in this group. The group receiving G-BDQ presented with neither statistically ( p > 0.05) nor clinically significant changes in hearing thresholds across all frequencies over the same monitoring timeframe. Additionally, only one report (7%) of tinnitus was found in this group. Conclusion The results indicating that bedaquiline does not cause hearing loss when compared with G-KCIN highlight the need for increased availability of bedaquiline for the treatment of DR-TB within the South African context, to preserve both the quantity and quality of life of those infected.

Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review

“…Additionally, this will allow continued updating of evidence as advances in healthcare or reduced health inequities will influence the profile of priority functioning problems in the populations. For example, hearing loss may no longer be a priority functioning loss as new drug treatments with less ototoxic side-effects, e.g., Bedaquiline versus Kanamycin become more available in low-resource settings [ 197 ]. Other countries may access or contribute to the data to provide better comparisons of contextually similar settings.…”

Social determinants of health in non-communicable diseases prevention policies in South Africa

“…(5) early audiological interventions, including minimised exposure to noise while on ototoxic treatment, and so on (Govender & Paken 2015;Guo et al 2010;Khoza-Shangase, Lecheko & Ntlhakana 2020b; Khoza-Shangase & Prodromos 2021;Tsintis & La Mache 2004).…”

Tele-audiology and preventive audiology: A capacity versus demand challenge imperative in South Africa

“…Although it is well recognised and accepted that priority to sustain lives during the treatment of life-threatening conditions such as HIV and AIDS trumps the concerns around the highly ototoxic nature of the agents used, preventive strategies still remain relevant. Sufficient evidence exists that demonstrates that preventive measures, such as prescription of alternative drugs, altered treatment regimens or administration of reduced dosages, are successful options if ototoxicity is identified early in the treatment phase (Khoza-Shangase & Prodromos 2021;Lonsbury-Martin & Martin 2001). Prospective audiological monitoring of high-frequency hearing allows the prescribing doctor to consider and weigh the advantages of alternative treatment and/or amount, mode and frequency of treatment prior to worsening hearing loss to invade the lower range of frequencies that are significant for speech and communication.…”

“…Such contextually relevant findings have the potential to positively sway political will through the delivery of evidence that clearly promotes early ototoxicity detection and monitoring. In another South African study, where the aim was to describe the audiological function in adult patients with MDR-TB on bedaquiline treatment, the less ototoxic nature of bedaquiline was established (Khoza-Shangase & Prodromos 2021). Such evidence has implications for risk-benefit evaluations within a resourceconstrained context like South Africa.…”