Hearing loss in children associated with common antibiotics

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As in adults, sensorineural hearing loss (SNHL) in children, adolescents, and young adults may be related to the use of oral macrolides.

Compared to their peers without SNHL, pediatric patients with SNHL were more likely to have received a macrolide prescription compared to a penicillin prescription (adjusted OR 1.31, 95% CI 1.05-1.64), particularly when diagnosis and testing occurred more than 180 days after antibiotic therapy. exposure (adjusted OR 1.79, 95% CI 1.23-2.60), according to a case-control study in JAMA Otorhinolaryngology – Head and Neck Surgery.

Study author Jennifer Shin, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and her colleagues warned of “substantial” public health consequences, estimating 7,000 cases of SNHL per 1 million macrolide prescriptions.

They cited previous research reporting SNHL in adults with comorbidities following high-dose, intravenous macrolide therapy. Notably, the effect of macrolide therapy has not been widely studied in children.

Azithromycin, clarithromycin and erythromycin are among the the most frequently prescribed macrolide antibiotics used to treat a wide variety of bacterial infections.

“Macrolides are one of the most commonly used medications for children,” Shin’s group said. “Random household surveys have shown that 0.6% of children have used this drug in the last 7 days alone.”

Shin and colleagues emphasized early recognition of sudden SNHL given the limited treatment window.

For those affected by sudden SNHL, rapid hyperbaric oxygen therapy may be beneficial to recover hearing function. According to a 2018 meta-analysis, people receiving this treatment were 61% more likely to have full hearing recovery than those receiving standard corticosteroid therapy alone.

Several potential mechanisms lend plausibility to an SNHL effect of macrolides, Judith Lieu, MD, of Washington University School of Medicine in St. Louis, and Leonard Rybak, MD, PhD, of Southern Illinois University School of Medicine in Springfield, suggested in a editorial.

“The mechanisms underlying the ototoxic effects of macrolide antibiotics have not been fully elucidated. However, preliminary evidence suggests that the stria vascularis may be the target of erythromycin ototoxicity. ‘Erythromycin may present with transient or permanent flat sensorineural hearing loss or high frequency sensorineural hearing loss,’ they wrote.

“Further experimental studies are warranted to further determine the mechanisms of macrolide ototoxicity,” Lieu and Rybak added.

The present retrospective case-control study by Shin’s group was based on data from the U.S. military health insurance system TRICARE for uniformed service members, retirees, and their families.

Investigators searched outpatient records from October 2009 to September 2014 and analyzed 875 matched pairs of children, adolescents, and young adults with and without SNHL (mean age 5.7 years, 62% male and men and 66% non-Hispanic white).

The main limitation of the study was its inability to directly generate incidence data on SNHL. The available data also prevented the authors from adjusting for co-occurring dysfunctions such as renal, hepatic, and metabolic disorders; interethnic differences in cytochrome P450 pharmacokinetics and activity; and dosage based on weight.

In addition, retrospective use of an administrative claims database may be subject to coding errors and missing data.

  • James Lopilato is an editor for Medpage Today. It covers a variety of topics explored in current research in the medical sciences.

Disclosures

The study was funded by a grant from the US Department of Defense.

Shin disclosed book royalties from Springer and Plural Publishing and funding from the American Academy of Otolaryngology – Head and Neck Surgery Foundation, the Brigham Care Redesign Program Award, and the Schlager Family Innovations Fund Award.

Lieu and Rybak have reported no conflicts of interest.

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