Vestibular Toxicity Due to Gentamicin in Peritoneal Dialysis Patients

Abstract

Gentamicin is well known to be a cause of vestibular toxicity. Despite this, gentamicin is often used to treat peritonitis and exit site infections in peritoneal dialysis patients because of the ease of intraperitoneal administration and the broad coverage of aerobic Gram-negative bacilli, including Pseudomonas aeruginosa. We report 4 cases of severe vestibular toxicity occurring in peritoneal dialysis patients treated with gentamicin. They were all treated as outpatients for peritonitis or an exit-site infection while on continuous ambulatory peritoneal dialysis (CAPD) or continuous cyclic peritoneal dialysis (CCPD). The drug was administered to 3 patients in each peritoneal exchange (5 mglL) after a loading dose. A fourth patient was given 1 mglkg of intraperitoneal gentamicin every other day. The mean length of treatment was 21 days. Levels were not used to adjust the doses. All developed severe vertigo from which there was incomplete or no recovery. We suggest that gentamicin and the other aminoglycosides should be used in peritoneal dialysis patients only when there is no suitable alternative antibiotic. When gentamicin is administered, levels should be carefully followed. Studies should be performed in peritoneal dialysis patients on the feasibility of dosing gentamicin intermittently, which may be less toxic than continuous intraperitoneal administration.

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…256,257 Not unexpectedly, ototoxicity occurs with IP aminoglycosides, similar to systemic administration, as confirmed in both animal models 258 and human. 259,260 According to an observational study of PD patients, risk factors for hearing loss include older age, episodes of peritonitis and cumulative doses of amikacin and vancomycin. 166 The mechanism of aminoglycoside ototoxicity is incompletely understood.…”

Aminoglycoside-Induced Vestibular Injury: Maintaining a Sense of Balance

“…24 Indeed, this suspicion has been supported by a clinical study 18 (Table 1) and a case report of 4 patients with aminoglycoside-induced vestibular injury from intraperitoneal administration alone. 33 Gendeh et al 18 found a very high incidence of vestibular injury in patients receiving repeated courses of aminoglycosides for peritoneal dialysis-related peritonitis. Clearly, the little evidence that is available does not suggest that intraperitoneal administration minimizes this risk.…”

Vestibulo-ocular Physiology Underlying Vestibular Hypofunction

“…101 For people who receive gentamicin and renal dialysis concurrently, it is estimated that the likelihood of sustaining BVH is from 12.5% to 30%. 102,103 Unfortunately, it appears that people who are susceptible to ototoxicity have little protection from monitoring serum levels of these antibodies. 104 Less common causes of BVH include meningitis, head trauma, tumors on each eighth cranial nerve (including bilateral vestibular schwannoma), transient ischemic episodes of vessels supplying the vestibular system, and sequential unilateral vestibular neuronitis.…”