Gentamicin-induced ototoxicity in a carefully monitored renal-failure patient.

A case of gentamicin-induced ototoxicity, documented by electronystagmography and audiometry, in a patient with chronic renal failure is presented. A 39-year-old white man was hospitalized for a renal transplant procedure. Multiple postoperative complications included infection, and the transplanted kidney was rejected eventually. The patient was carefully monitored with frequent serum gentamicin determinations and subsequent pharmacokinetic analysis throughout the six-week course of therapy. Ototoxicity became apparent 10 days after the discontinuance of gentamicin therapy even though predicted and measured levels never fell outside the range of 1.5 to 6.0 microgram/ml throughout the period of antibiotic administration. A brief review of the presentation of gentamicin ototoxicity with special emphasis on the renal-failure patient is included. Clinicians should be aware of potential toxicities and must be able to recognize those patients at high risk. Patients must be monitored carefully, and a risk-benefit analysis should precede proposed therapy.