GENTAMICIN OTOTOXICITY IN CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

A prospective study was undertaken of 10 chronic renal failure patient s on Continuous Ambulatory Peritoneal Dialysis (CAPD) complicated by r epeated bouts of peritonitis treated with gentamicin. Each 10-day trea tment course consisted of a 120 mg loading dose, followed by 16 mg in 21 of peritoneal dialysate, given four times a day. Serum gentamicin a nalysed by enzyme immunoassay showed a mean level of 5.2 mug/ml, (rang e 3.7 to 6.6 mg/ml) four hours after the loading dose. Similar levels, well within the therapeutic range, were maintained on the 3rd, 5th, 7 th and 9th days of intraperitoneal gentamicin therapy, suggesting no a ccumulation of gentamicin in the serum. Pure tone audiometry, electron ystagmography and clinical assessment were performed during each cours e of treatment. Although no evidence of ototoxicity was found during t he first two courses of gentamicin, but disequilibrium and bobbing osc illopsia were present during the third and fourth courses of gentamici n. These findings could be explained by cumulative injury to the vesti bular apparatus caused by repeated therapeutic insults.