MY DIAGNOSIS

Below are some of the most common medical diagnoses we encounter from our clients that received aminoglycoside treatment and suffered ototoxic side effects.  There is no possible way to discuss every scenario and treatment; however, for the newly damaged person, this may provide some insight into your specific condition. 

Chronic sinusitis:  Aminoglycoside containing sinus rinses are often used to treat chronic sinusitis, even though studies have demonstrated appreciable systemic aminoglycoside absorption after use.  The concentration of gentamicin or tobramycin used in these rinses, and the length of therapy is often a critical issue. 

Dialysis catheter infection:  Peritoneal dialysis often leads to a catheter tip infection or the development of peritonitis.  Gentamicin is often prescribed as an additive to peritoneal dialysis fluid to combat these infections.  Issues arise when gentamicin is the inappropriate choice of antibiotic, when the dose is excessive, when the length of treatment is excessive, or when there is inadequate monitoring of blood gentamicin levels.  Generally, replacement of an infected catheter is required.

Enterococcal Endocarditis:  Infective endocarditis is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect. Infective endocarditis is caused by a variety of pathogens. Of particular interest here is endocarditis caused by the organisms Enterococcus faecalis and Enterococcus faecium, because it represents one of the few instances where the use of gentamicin is currently justified.

Gentamicin is most often used as a synergistic agent in the treatment of endocarditis.  For over 30 years, the use of a penicillin like antibiotic (beta-lactam) plus a low dose of an aminoglycoside such as gentamicin has been the mainstay for treatment of enterococcal endocarditis. It is still considered within the standard of care to use a combination of ampicillin and gentamicin for six weeks, or vancomycin and gentamicin for six weeks in non-native enterococcal endocarditis.

In our practice, we have encountered clients who have been diagnosed with enterococcal endocarditis and prescribed gentamicin.  Unfortunately, some of the prescribing physicians or pharmacies did not understand the concept of synergistic dosing, and administered gentamicin at a higher dose level for several weeks.  Not surprisingly, these clients suffered from gentamicin poisoning.

Meniere’s disease:  An acceptable treatment for severe unilateral Meniere’s Disease is the intentional introduction of gentamicin into the affected ear to completely destroy the vestibular system on that side.  This results in total dependence on the “good” ear for balance information.  However, cases have been reported where the therapy has affected the “good” ear also, causing the symptoms of bilateral vestibulopathy.

Osteomyelitis:  Osteomyelitis, or infection of the bone, can be caused by a number of different bacteria.  Certain gram-negative bacteria are susceptible to gentamicin or tobramycin, and in certain circumstances, there is a rational use of a course of IV gentamicin to treat the infection.  However, we have encountered a number of cases where gentamicin was negligently prescribed.  Each case must be examined in detail to determine whether the use of an aminoglycoside was within the standard of care.

Tularemia: Tularemia is an infection caused by Francisella tularensis, a gram-negative bacterium. Human infection occurs following contact with infected animals or invertebrates.  The clinical manifestations of Tularemia infection may range from asymptomatic illness to septic shock and death.  This is one illness where there is a clear indication that a course of gentamicin given for 7 to 10 days is the preferred and accepted treatment.

UTI:  Urinary tract infections, including cystitis and pyelonephritis are often treated with short courses of low dose aminoglycosides.  Because aminoglycosides are concentrated in the urine, lower doses of aminoglycosides are sufficient.  Vestibulopathy can occur if the dose is excessive, or if the duration of treatment is prolonged.

Wound infections caused by diabetic pressure sores:  Diabetes can significantly delay and complicate wound healing.  Unhealed wounds become a virtual petri dish for pathogenic bacteria to multiply, and the lack of adequate peripheral circulation makes treatment with systemic antibiotics difficult.  In certain circumstances, there may be a rational use of gentamicin to treat a highly resistant infection, but these cases are rare.  Only by performing a detailed analysis of the treatment, and exploring the underlying medical condition of the patient can a rational determination of whether the use of aminoglycosides was warranted, or was negligent.

Wound infections caused by injury:  There is potentially a rational use for short term aminoglycosides in the treatment of wound infections, such as a compound fracture where the bone is contaminated with a source such as raw sewage  or feces.  Unless there is a culture proven, highly  resistant bacteria recovered, there is usually no reason to give an aminoglycoside long term.