ototoxicity from aminoglycosides

 Q; Concomitant use of which pharmacological agent may help to prevent the ototoxicity of aminoglycosides?

Answer; N-acetylcysteine (NAC) 

Ototoxicity from aminoglycoside is due to oxidative stress. N-acetylcysteine (NAC) is a thiol-containing antioxidant. It is so far largely studied in End-Stage Renal Disease (ESRD) patients who are either on peritoneal dialysis (PD) or hemodialysis (HD) and received either intraperitoneal amikacin or intravenous gentamicin respectively. It has shown significantly improved outcomes. 

Despite weak evidence, it is recommended to concomitantly prescribe NAC to all patients who receive an aminoglycoside, as it is potentially a benign intervention but may benefit the patient. 

Besides NAC, aspirin has also been suggested as protective in aminoglycoside-induced ototoxicity.

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References:

1. Feldman L, Efrati S, Eviatar E, et al. Gentamicin-induced ototoxicity in hemodialysis patients is ameliorated by N-acetylcysteine. Kidney Int 2007; 72:359. 

2. Tokgoz B, Ucar C, Kocyigit I, et al. Protective effect of N-acetylcysteine from drug-induced ototoxicity in uraemic patients with CAPD peritonitis. Nephrol Dial Transplant 2011; 26:4073. 

3. Tepel M. N-Acetylcysteine in the prevention of ototoxicity. Kidney Int 2007; 72:231. 

4. Chen Y, Huang WG, Zha DJ, et al. Aspirin attenuates gentamicin ototoxicity: from the laboratory to the clinic. Hear Res 2007; 226:178. 

5. Sha SH, Qiu JH, Schacht J. Aspirin to prevent gentamicin-induced hearing loss. N Engl J Med 2006; 354:1856.