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Ototoxic Drugs and Poor Renal Function

Gregory J. Matz, MD; Ralph F. Naunton, MD
JAMA. 1968;206(9):2119. doi:10.1001/jama.1968.03150090195037.
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To the Editor:—  The ototoxicity of various antibiotics such as streptomycin, kanamycin, and neomycin seems well understood by the general medical community. However, less well recognized is the severe ototoxicity that can result when these drugs are used in low doses in the presence of impaired renal function. Our recent experience with a well-established ototoxic drug, kanamycin, and with a newly developed ototoxic drug, ethacrynic acid, may serve to illustrate this danger.Kanamycin's ototoxicity on a dose-related basis has been well established. However, the dose-related toxicity in the presence of poor renal function has not been established.Naunton and Ward,1 Matz and Ward,2 and Benitz et al3 have all reported cases of profound sensorineural loss developing in patients with renal disease who received kanamycin. In Naunton's two cases low dosages were used, 14 gm in seven days and 5 gm in five days. Frost et al4


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