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BMC Infect Dis. 2014 Oct 9;14:542. doi: 10.1186/1471-2334-14-542.

Successful MDR-TB treatment regimens including amikacin are associated with high rates of hearing loss.

Author information

1
Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA. nzetola@gmail.com.

Abstract

BACKGROUND:

Aminoglycosides are a critical component of multidrug-resistant tuberculosis (MDR-TB) treatment but data on their efficacy and adverse effects in Botswana is scarce. We determined the effect of amikacin on treatment outcomes and development of hearing loss in MDR-TB patients.

METHODS:

Patients started on MDR-TB treatment between 2006 and 2012 were included. Multivariate analysis was used to determine the effect of amikacin on treatment outcomes and development of hearing loss.

RESULTS:

437 MDR-TB patients were included, 288 (66%) of whom were HIV co-infected. 270 (62%) developed hearing loss, of whom 147 (54%) had audiometry. Of the 313 (72%) patients who completed treatment, 228 (73%) had a good outcome (cure or treatment completion). Good outcome was associated with longer amikacin treatment (adjusted OR [aOR] 1.13, 95% CI 1.06 - 1.21) and higher dosage (aOR 1.90, 95% CI 1.12 - 2.99). Longer amikacin duration (aOR 1.98, 95% CI 1.86 - 2.12) and higher dosage per weight per month (aOR 1.15, 95% CI 1.04 - 1.28) were associated with development of hearing loss. Amikacin treatment duration modified the effect of the dosage on the risk of hearing loss, increasing this risk as the duration increased.

CONCLUSIONS:

Amikacin was effective for MDR-TB treatment, but was associated with a high incidence of hearing loss especially in our study population. Total treatment duration and average monthly amikacin dose were associated with improved outcomes; however these were also associated with development of hearing loss.

PMID:
25300708
PMCID:
PMC4287509
DOI:
10.1186/1471-2334-14-542
[Indexed for MEDLINE]
Free PMC Article

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