Kids’ Hearing Loss Associated With Common AntibioticsJuly 22, 2022
As with adults, sensorineural hearing loss (SNHL) in children, adolescents, and young adults could be linked to oral macrolide use.
Compared with 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), especially when the diagnosis and testing occurred more than 180 days after antibiotic exposure (adjusted OR 1.79, CI 95% 1.23-2.60), according to a case-control study in JAMA Otolaryngology-Head & Neck Surgery.
Study author Jennifer Shin, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues warned of the “substantial” consequences for public health, estimating 7,000 SNHL cases for every 1 million macrolide prescriptions.
They cited prior research reporting SNHL in adults with comorbid conditions after high-dose and intravenous macrolide therapy. Notably, the effect of macrolide therapy had not been extensively studied in children.
Azithromycin, clarithromycin, and erythromycin are among 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. “Surveys of randomly selected households have shown that 0.6% of children have used this medication within the last 7 days alone.”
Shin and colleagues stressed early recognition of sudden SNHL given the limited treatment window.
For those affected by sudden SNHL, prompt hyperbaric oxygen therapy may be beneficial for recovering hearing function. Those receiving this treatment were 61% more likely to have complete hearing recovery than those receiving standard corticosteroid therapy alone, according to a meta-analysis from 2018.
Several potential mechanisms lend plausibility to a SNHL effect from macrolides, Judith Lieu, MD, from Washington University School of Medicine in St. Louis, and Leonard Rybak, MD, PhD, from Southern Illinois University School of Medicine in Springfield, suggested in an 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 for erythromycin ototoxicity. Patients with erythromycin ototoxicity may exhibit a transient or permanent flat sensorineural hearing loss or a high frequency sensorineural hearing loss,” they wrote.
“Additional experimental studies are warranted to determine more precisely the mechanisms of ototoxicity of macrolides,” added Lieu and Rybak.
The present retrospective case-control study from Shin’s group was based on data from the TRICARE U.S. military health insurance system for uniformed service members, retirees, and their families.
Investigators sought records on outpatient encounters 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% boys and men, and 66% non-Hispanic white).
Chief among the study’s limitations was its inability to directly generate incidence data on SNHL. The available data also precluded authors from adjusting for concurrent dysfunctions such as kidney, liver, and metabolic conditions; inter-ethnic differences in pharmacokinetics and cytochrome P450 activity; and weight-based dosing.
Furthermore, retrospective use of an administrative claims database may be subject to coding errors and missing data.
The study was funded by a grant from the U.S. 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 reported no conflict of interest.