Ototoxicity among patients receiving Multidrug-Resistant tuberculosis treatment; Experience from a tertiary care hospital

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is an increasing challenge to health services globally. Although new drugs are in development, current guidelines still recommend prolonged use of injectable antimicrobials (usually Amikacin, Kanamycin or Capreomycin).Methods: We conducted a retrospective study of patients initiating treatment for MDR-TB at Programmatic Management of Drug Resistant TB unit, Lady Reading Hospital (PMDT-LRH) Peshawar between January 2012 and December 2013.Objective: Objective of the present study is to find out the incidence of ototoxicity (defined both clinically and on audiological testing), its associated factors and its effects on final outcome.Results: The choice of injectable antimicrobial varied. Total of 543 patients treated with injectable antimicrobials for MDR-TB were included in the analysis. Of 543 MDR-TB patients, 476 (87.7%) received amikacin and 67 (12%) received capreomycin. All the patients received baseline screening by audiometry at the time of registration for MDR-TB treatment and 36.83% had more than one audiogram.Among 543 patients, 200 (36.83%) patients showed evidence of ototoxicity. Most of the male patients (p= 0.010), age between 25 to 44 (p= 0.012), comorbidity (p= 0.023), duration of illness (p=0.010), past TB treatment outcome (p= 0.047) and use of amikacin (p= 0.031) were significantly associated with ototoxicity.Conclusions: Long-term morbidity from injectable treatment is significant in this setting, and the data suggest capreomycin might be associated with less ototoxicity when compared with amikacin. There is a need for more highquality clinical data to inform future guidelines for treatment and monitoring.