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December 1986

Relative Efficacy and Toxicity of Netilmicin and Tobramycin in Oncology Patients

Author Affiliations

From the Section of Infectious Disease, Marshall University School of Medicine and Huntington Veterans Administration Medical Center, Huntington, WV (Drs Bernstein and Gorse); the Pharmaceutical Research Division, Schering-Plough Corp, Kenilworth, NJ (Drs Linzmayer and Lorber); the Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Pegram); the Division of Hematology and Oncology, Mount Sinai Hospital, Chicago (Dr Levin); the Department of Otolaryngology, The Oregon Health Sciences University, Portland (Dr Brummett); and the Division of Infectious Diseases and Hospital Epidemiology, Henry Ford Hospital, Detroit (Drs Markowitz and Saravolatz). Dr Bernstein is currently with the Veterans Administration Medical Center, Dayton, Ohio.

Arch Intern Med. 1986;146(12):2329-2334. doi:10.1001/archinte.1986.00360240043008

• We prospectively compared the efficacy and safety of netilmicin sulfate or tobramycin sulfate in conjunction with piperacillin sodium in 118 immunocompromised patients with presumed severe infections. The two treatment regimens were equally efficacious. Nephrotoxicity occurred in a similar proportion in patients treated with netilmicin and tobramycin 17% vs 11%). Ototoxicity occurred in four (9.5%) of 42 netilmicin and piperacillin and in 12 (22%) of 54 tobramycin and piperacillin—treated patients. Of those evaluated with posttherapy audiograms, three of four netilmicin and piperacillin—treated patients had auditory thresholds return to baseline compared with one of nine tobramycin and piperacillin—treated patients. The number of ≥15-dB increases in auditory threshold as a proportion of total ≥15-dB changes (increases and decreases) was significantly lower in netilmicin and piperacillin— vs tobramycin and piperacillin—treated patients (18 of 78 vs 67 of 115). We conclude that aminoglycoside-associated ototoxicity was less severe and more often reversible with netilmicin than

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