Gentamicin and ototoxicity: why this drug is still in use

The fine line between therapeutic benefit and toxicity

In this issue of the Journal, Ahmed and colleagues1 focus our attention on the very real problem of gentamicin-induced ototoxicity, and especially on the frequently unrecognised problem of severe vestibulotoxicity. Their retrospective analysis of gentamicin-treated patients presenting to a balance disorders clinic found delayed clinical detection of vestibulotoxicity and an apparent lack of a relationship between toxicity and dose. While hearing loss can be a feature of gentamicin ototoxicity, it is uncommon and usually clinically insignificant. The most concerning aspect of the analysis is the authors’ inability to demonstrate any relationship between vestibulotoxicity and gentamicin doses, dosing schedules or exposure (ie, peaks and/or troughs).1