Amikacin treatment for multidrug resistant tuberculosis: how much monitoring is required?

Amikacin treatment for multidrug resistant tuberculosis: how much monitoring is required?To the Editor:Multidrug-resistant tuberculosis (MDR-TB) is an increasing global problem.The World Health Organization (WHO) guidelines state that all patients suspected of MDR-TB should be given a group 2 injectable agent, usually an aminoglycoside.However, when taken for extended periods, these can cause nephrotoxicity, neurotoxicity and irreversible ototoxicity [1,2].Aminoglycoside-associated progressive hearing loss, from high to low conversational frequency sounds (0.5-2 KHz), affects at least 19% of MDR-TB patients [3,4].Most assessments are based on self-reported hearing loss, which is likely to significantly under-estimate the true proportion affected.Although both cochlear and vestibular functions can be impaired, the cochlea is predominantly damaged.This makes audiology testing, in particular serial audiograms that detect tone threshold changes, a useful way to assess ototoxicity, especially for non-conversational ultra-high frequency losses [3][4][5].