Intravenous Azithromycin‐Induced Ototoxicity

Bizjak, Eric D; Haug, Marcus T.; Schilz, Robert; Sarodia, Bipin D.; Dresing, Janna M.

doi:10.1592/phco.19.3.245.30930

Cited by 26 publications

(14 citation statements)

References 24 publications

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“…For oral azithromycin, the fastest recovery occurred in 5 days and the longest reported timeframe exceeded 3 months, with one unreported follow‐up time . Intravenous azithromycin was associated with recovery 20 days after cessation . For oral erythromycin, dramatic improvements were subjectively reported immediately after cessation and confirmed in other cases at 48 hours .…”

Section: Resultsmentioning

confidence: 73%

“…26,29 Intravenous azithromycin was associated with recovery 20 days after cessation. 62 For oral erythromycin, dramatic improvements were subjectively reported immediately after cessation 63 and confirmed in other cases at 48 hours. 63 Recovery times, however, were as long as 4 months.…”

Section: Irreversibility/reversibility Of Sensorineural Hearing Lossmentioning

confidence: 83%

“…In addition to the above audiometrically confirmed cases, there also were 42 reported cases of subjective hearing loss, ranging from diminished ability to hear spoken words to gradual decline to tinnitus and “complete deafness” (Appendices 5–6).…”

Section: Resultsmentioning

confidence: 99%

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Macrolide‐associated sensorineural hearing loss: A systematic review

et al. 2017

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Objectives: To investigate the potential association of macrolide antibiotics with sensorineural hearing loss (SNHL) and which agents and dosage may be related. To evaluate whether an optimal treatment exists for reversing SNHL that occurs after macrolide therapy.Study Design: Systematic review of the literature. Methods: Computerized (PubMed, EMBASE, Cochrane Library) and manual searches were performed to identify human studies of all ages (patients) who received macrolides (intervention, with or without control) and documented SNHL (outcome). All study designs were assessed. Extracted data included macrolide regimen details, as well as the timing, severity, and reversibility of SNHL with drug cessation alone or with additional medical intervention. Study designs and the associated risk of bias were assessed.Results: The 44 publications (3 prospective, 41 retrospective) that met these criteria described 78 cases of audiometrically confirmed SNHL. SNHL was associated with oral and intravenous macrolide administration at standard and elevated doses. SNHL was irreversible in six cases, despite macrolide cessation (n 5 5) and oral steroid treatment (n 5 1). Irreversible SNHL was observed following 2 to 3 days of exposure. SNHL was reversible with macrolide cessation alone in 70 cases. In two cases, macrolide cessation coupled with oral steroid administration restored hearing. Reversible cases improved within hours to days. Nine studies also described 42 cases of subjective patient-reported hearing loss. Limitations in the data arose from study design, related comorbidities, and concomitant drug administration.Conclusion: SNHL may follow macrolide exposure, even at standard oral doses. Further research is needed to understand the incidence, prevalence, and biological mechanism of its ototoxicity.

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Section: Resultsmentioning

confidence: 73%

Section: Irreversibility/reversibility Of Sensorineural Hearing Lossmentioning

confidence: 83%

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Macrolide‐associated sensorineural hearing loss: A systematic review

et al. 2017

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“…This antibiotic is considered relatively safe in adults, children, and pregnant women [13]. However, a number of side effects have been identified especially with intravenous administration, which may be associated with gastrointestinal disturbances, ototoxicity, and pain and inflammation of the injection site [14] The development of resistant bacteria, [15] and its association with proarrhythmic events [16] have also been reported. The latter risk has been attributed to QT prolongation (summation of action potential of ventricular myocytes), which can lead to a life-threatening arrhythmia; however, susceptible patients usually have other co-factors such as old age, heart disease, and exposure to other QT prolonging drugs [17].…”

Section: Azithromycinmentioning

confidence: 99%

COVID-19: Present and Future Challenges for Dental Practice

Dar‐Odeh

Babkair

Abu‐Hammad

et al. 2020

IJERPH

145

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COVID-19 was declared a pandemic by the World Health Organization, with a high fatality rate that may reach 8%. The disease is caused by SARS-CoV-2 which is one of the coronaviruses. Realizing the severity of outcomes associated with this disease and its high rate of transmission, dentists were instructed by regulatory authorities, such as the American Dental Association, to stop providing treatment to dental patients except those who have emergency complaints. This was mainly for protection of dental healthcare personnel, their families, contacts, and their patients from the transmission of virus, and also to preserve the much-needed supplies of personal protective equipment (PPE). Dentists at all times should competently follow cross-infection control protocols, but particularly during this critical time, they should do their best to decide on the emergency cases that are indicated for dental treatment. Dentists should also be updated on how this pandemic is related to their profession in order to be well oriented and prepared. This overview will address several issues concerned with the COVID-19 pandemic that directly relate to dental practice in terms of prevention, treatment, and orofacial clinical manifestations.

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“…ketoconazole) and appears to recover in the range of 4 to 11 weeks after discontinuing the macrolide. 14 In the most recent study of long-term macrolide therapy in chronic disease, Albert et al, 15 reported hearing decrements in 25% of subjects taking azithromycin and 20% of subjects allocated to placebo (p ¼ 0.04). Discontinuation of treatment led to improvements in audiogram results in 34% of patients taking azithromycin vs. 38% of patients taking placebo.…”

Section: Issues In Development Of Anti-inflammatory Macrolidesmentioning

confidence: 99%

Anti-Inflammatory Macrolides to Manage Chronic Neutrophilic Inflammation

Burnet

Guse

Gutke

et al. 2014

Macrocycles in Drug Discovery

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Macrolide antibiotics, notably azithromycin, have clinically useful effects in a range of inflammatory diseases and especially those of the lung. Effects include a reduction of inflammatory cytokines, reductions in neutrophil infiltration and potentially a polarisation of infiltrating cells to a pro-resolution phenotype. The mode of action behind this effect is unlikely to be a single interaction and may involve reductions in prostaglandin synthesis via phospholipase inhibition, modulation of NFκB translocation, reduction in IL-8 production and reduction in reflux aspiration to the airways. While some of the clinical effects can be rationalised through antibacterial actions leading to changes in normal flora and reducing Pseudomonads in particular, there is also evidence for effects unrelated to antibacterial actions that appear to relate to reductions in neutrophil activation, potentially related to high accumulation in neutrophil lysosomes. Concerted efforts to improve on these effects have focused on either generating non-antibacterial analogues, or in conjugating anti-inflammatory drugs to the macrolide backbone. Both approaches have provided strong pre-clinical data suggesting that the selective disposition of macrolides to inflamed tissue, as well as their pleiotropic effects on immune cells, contribute to their broad anti-inflammatory effects. The more recent observations of stronger macrolide effects in the context of neutrophil-mediated disease and corresponding effects on IL-17 positive cells in tissue suggest that it may be possible to select patients likely to respond to macrolide therapy. The discovery of non-antibacterial macrolides that preserve this anti-inflammatory effect provides a means to bring these effects more broadly to the clinic without selecting for large-scale resistance to antibacterial macrolides or to other anti-infectives via cross-resistance.

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Intravenous Azithromycin‐Induced Ototoxicity

Cited by 26 publications

References 24 publications

Macrolide‐associated sensorineural hearing loss: A systematic review

Macrolide‐associated sensorineural hearing loss: A systematic review

COVID-19: Present and Future Challenges for Dental Practice

Anti-Inflammatory Macrolides to Manage Chronic Neutrophilic Inflammation

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