Use of macrolides closely associated with sensorineural hearing loss: JAMA

A new study published in the Journal of American Medical Association suggests that in comparison to penicillin, outpatient oral macrolide usage was more likely associated with sensorineural hearing loss (SNHL) in children, adolescents, and young adults.

For adults with coexisting disorders, intravenous or high-dose macrolide treatment has been linked to the occasional development of sensorineural hearing loss; however, studies evaluating the auditory effects of oral outpatient dosage for children, adolescents, and young adults have been few. In order to ascertain if widespread outpatient use of oral macrolide treatment is linked to a higher incidence of juvenile SNHL by nationally representative analyses, Kirsten F. A. A. Dabekaussen and colleagues undertook this investigation.

875 matched pairs of kids, teens, and young adults who were matched for age, sex, and the amount of time since the prescription date were used in a retrospective case-control research. The TRICARE US military health insurance program's matched control participants, who were assessed between October 1, 2009, and September 30, 2014, were included with all eligible pediatric patients. When compared to the usage of penicillin among pediatric patients, exposure was conducted as an oral outpatient macrolide therapy. In terms of clinical outcomes, SNHL in children, adolescents, and young adults was of interest. After adjusting for other risk variables and possible confounders, multivariable conditional logistic regression was performed to compare the risk of past exposure to macrolides with that of prior exposure to penicillin. Additionally, four intervals between exposure and diagnosis were evaluated.

The key findings of this study were as follow:

1. 875 suitable matched pairs of children, teens, and young adults were composed.

2. The participants' average (standard deviation) age was 5.7 (4.9); 62% of them were male; 58 had Asian ancestry; 254 were Black; 1152 were White; and 286 belonged to Native American and other (no further breakdown was provided in the TRICARE database) racial and ethnic groups (16% ).

3. When all time frames from exposure were taken into account in the multivariable analysis, persons who had SNHL had higher probabilities of having had a prescription for a macrolide as opposed to a penicillin.

4. When diagnosis and testing took place more than 180 days after antibiotic exposure, the odds of being exposed to macrolides were considerably greater than those of being exposed to penicillin.

Reference: 

Dabekaussen, K. F. A. A., Andriotti, T., Ye, J., Prince, A. A., Nguyen, L. L., Feng, A. Y., Chen, J. X., & Shin, J. J. (2022). Association of Outpatient Oral Macrolide Use With Sensorineural Hearing Loss in Children, Adolescents, and Young Adults. In JAMA Otolaryngology–Head & Neck Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamaoto.2022.1293