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Vestibular Toxicity of Gentamicin in the Presence of Renal Disease

Franklin D. Schwartz, MD
Arch Intern Med. 1978;138(11):1612-1613. doi:10.1001/archinte.1978.03630360010007.
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A minoglycoside antibiotics are widely used in treatment of serious Gram-negative infections. In addition, they are used in combination with penicillins to treat enterococcal infections and with penicillinase-resistant penicillins or cephalosporins for staphylococcal infections.

Currently available aminoglycoside antibiotics include streptomycin, neomycin, paromomycin, gentamicin, tobramycin, and amikacin. Several newer compounds are still under investigation.

Unlike other antibiotics, such as penicillin, therapeutic levels of the aminoglycosides are perilously close to toxic levels—the therapeutic index is small. Further, selection of the optimal dosage is difficult because of considerable variation from subject to subject, both in peak blood levels produced by a given dose and also in serum half-life of the antibiotic.1-3

This problem is magnified for patients with renal insufficiency and even further exaggerated for those receiving long-term hemodialysis. A number of approaches have been proposed for dosage determination in the presence of reduced renal function. Most utilize various forms of equations


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