Debilitating Gentamicin Ototoxicity: Case Report and Recommendations Against Routine Use in Surgical Prophylaxis

Abstract Purpose: Aminoglycoside antibiotics such as gentamicin are bactericidal and effective against gram negative organisms and methicillin-resistant Staphylococcus aureus. However, they have serious adverse effects such as nephrotoxicity and ototoxicity. Gentamicin ototoxicity may occur after a single dose and results in decreased vestibular function, which is frequently debilitating and often permanent. The purpose of this report is to describe a case of ototoxicity after a single dose of gentamicin for surgical prophylaxis and suggest second-line antibiotics in penicillin-allergic patients undergoing colorectal surgery.Methods: A case is described of a woman with preexisting Meniere’s Disease who received gentamicin perioperatively for a sigmoidectomy. Results: The patient developed severe ototoxicity preventing her from working or driving. Gentamicin is indicated for surgical prophylaxis when a patient has a true allergy to penicillins and cannot receive cephalosporins, though alternatives exist. True allergies include IgE-mediated illness (anaphylaxis, bronchospasm, or urticaria 30-60min after administration) or exfoliative reactions (Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis). Conclusion: The authors encourage more prudent use of gentamicin, especially in patients susceptible for debilitating otologic insults, and offer recommendations for alternative agents in colorectal surgery prior to choosing gentamicin.