Chong T K, Piraino B, Bernardini J
Department of Medicine, University of Pittsburgh, Pennsylvania.
Perit Dial Int. 1991;11(2):152-5.
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 mg/L) after a loading dose. A fourth patient was given 1 mg/kg 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.
庆大霉素是众所周知的前庭毒性的一个成因。尽管如此，由于腹腔内给药方便且对包括铜绿假单胞菌在内的需氧革兰氏阴性杆菌有广泛的覆盖范围，庆大霉素仍常被用于治疗腹膜透析患者的腹膜炎和出口处感染。我们报告了4例在接受庆大霉素治疗的腹膜透析患者中发生严重前庭毒性的病例。他们在进行持续性非卧床腹膜透析（CAPD）或持续性循环腹膜透析（CCPD）时，均作为门诊患者接受腹膜炎或出口处感染的治疗。在给予负荷剂量后，每一次腹膜交换时向3例患者给药（5毫克/升）。第4例患者每隔一天给予1毫克/千克腹腔内注射庆大霉素。平均治疗时长为21天。未根据血药浓度调整剂量。所有患者均出现严重眩晕，且恢复不完全或未恢复。我们建议，只有在没有合适的替代抗生素时，才应在腹膜透析患者中使用庆大霉素和其他氨基糖苷类药物。当使用庆大霉素时，应密切监测血药浓度。应对腹膜透析患者进行研究，以探讨间歇性给予庆大霉素的可行性，这种给药方式可能比持续腹腔内给药毒性更小。
