Personalized treatment lowers risk of hearing impairment from tuberculosis

The risk of developing a hearing impairment drops when tuberculosis patients are prescribed a more individual dose of the antibiotic Aminoglycoside than when they are treated in line with the World Health Organization (WHO) guidelines. This is the conclusion of an article written by UMCG hospital pharmacist Dr Jan-Willem Alffenaar and other researchers, published in the journal Antimicrobial Agents and Chemotherapy. The results could ultimately lead to an amendment of the guidelines for treating tuberculosis.

The lung disease tuberculosis is treated with a cocktail of antibiotics, including aminoglycosides. Standard treatment lasts around six months, but can last up to twenty to twenty-four months in the case of resistant tuberculosis. The long-term use of antibiotics can cause serious side effects. Aminoglycosides, for example, can cause kidney damage and permanent hearing impairment when used for several months. Alffenaar: ‘Although this is a problem in the Netherlands, here we can at least provide people with hearing aids. This isn’t always the case in third-world countries, where there simply isn’t enough money and a hearing impairment can have much more serious implications for someone ’ s position in society.’

Personalized treatment

The World Health Organization has drawn up guidelines for prescribing a standard dose of Aminoglycoside. ‘In the Netherlands, we are trying to personalize the dose to suit the patient’, explains Alffenaar. ‘This means that we haven’t been prescribing the standard dose for the past ten years. We first measure the sensitivity of the bacteria causing the tuberculosis and the level of antibiotics in the blood, and then use the results to decide how much Aminoglycoside to prescribe.’ This is often lower than stated in the guidelines.

‘Two PhD candidates, Richard van Altena and Koos Dijkstra, collected and analysed data from patients treated during the past ten years. The results showed that here, only about 10% of patients developed hearing problems, while worldwide, this figure is over 40%. Furthermore, there is no evidence that the lower dose of antibiotics is any less effective than a higher dose.’ The results of this multidisciplinary research, carried out by various medical specialists and pharmacists, fit in well with one of the goals set by the WHO: to aim for treatments suited to individual patients.

Larger experiment

Personalized doses appear to be beneficial to patients. Alffenaar is now setting up a larger experiment to get a better idea of the effects. ‘Our aim is to set up a research project in a country that still works according to the WHO guidelines, and compare treatment with the personalized method used in the Netherlands. We are currently working with hospitals in Belarus and China, where resistant tuberculosis is much more common.’

Read the publication in Antimicrobial Agents and Chemotherapy