A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.
The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).
Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.
Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.
Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.
Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.