405Risk of gentamicin vestibulotoxicity with different dosing regimens: a retrospective cohort study
Bibliographic record
Abstract
Background. Gentamicin is used for the treatment of resistant gram-negative bacterial infections. Studies comparing single-daily dosing (SDD) to multiple-daily dosing (MDD) show similar efficacy and less nephrotoxicity. Less is known about the effects of different dosing regimens on the development of ototoxicity. Among patients referred to our Multidisciplinary Neurotology Clinic (MNC), we compared the impact of SDD vs MDD of gentamicin in patients without acute kidney injury (AKI) on the development of vestibulotoxicity. Methods. Data was collected for consecutive patients referred to our MNC between 1993 and 2012, including patient demographics, medical co-morbidities, concurrent medications, gentamicin dosing regimen, indications for use, cumulative dose and duration of therapy-to-time of diagnosis of vestibulotoxicity, and presence of AKI, determined by history or 1.5-fold elevation in serum creatinine. Results. Forty-six patients were identified of whom 19 (43.1%) had no evidence of AKI. Eighteen (94.7%) had imbalance, 10 (52.6%) had oscillopsia (visual blurring with head movement), while only 1 (5.3%) and 2 (10.5%) complained of tinnitus and deafness, respectively. Vestibulotoxicity was confirmed through audiovestibular testing. Twelve patients had received SDD and 5 patients had received MDD; 2 were excluded from analysis because of incomplete dosing documentation. The median cumulative dose resulting in vestibulotoxicity in SDD compared to MDD patients was 4.8g (interquartile range (IQR) = 2.2-8.1g) vs 8.2g (IQR = 6.4-9.4g) (p = 0.009) and the median duration of therapy-to-time of diagnosis of vestibulotoxicity was 15d (IQR = 5-22d) vs 34.5d (IQR = 24.3-40.3d) (p = 0.03). Conclusion. In patients referred to our MNC without AKI, gentamicin vestibulotoxicity occurred at a lower cumulative dose and with a shorter duration of therapy if they had received SDD vs MDD. As vestibulotoxicity may result in permanent impairment, including an inability to return to work, prospective safety evaluation for both dosing regimens is warranted. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".