Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. 415-416 (doi:10.1542/peds.2006-2647)
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LETTER TO THE EDITOR

Could Hearing Loss Be Related to Delay in Administration of Other Antibiotics Rather Than Early Use of Vancomycin?

Bonita E. Lee, MD
Sarah E. Forgie, MD
Ari R. Joffe, MD
Joan L. Robinson, MD
Wendy L. Vaudry, MD
Department of Pediatrics
Stollery Children's Hospital
Edmonton, Alberta, Canada T6G 2J3

To the Editor.—

We read with interest the article "Early Vancomycin Therapy and Adverse Outcomes in Children With Pneumococcal Meningitis."1 An unexpected finding was the association between hearing loss as a complication of meningitis and early administration of vancomycin relative to other antibiotics. The study showed that, "[a]mong children with hearing loss, the median vancomycin start time was <1 hour (interquartile range: 0–1.5 hours), whereas that of children without hearing loss was 4 hours (interquartile range: 1–12 hours; P < .0005). With increasing vancomycin start time, the proportion of tested children with hearing loss decreased in stepwise fashion: <1 hour, 18 (78%) of 23; 1 to 2 hours, 6 (67%) of 9; 2 to 5 hours, 3 (33%) of 9; >5 hours, 5 (28%) of 18 (P < .006)."

Is it possible that the majority of the children who had hearing loss had, in fact, received vancomycin at 0 hour (ie, vancomycin was given before the other antibiotics)? Studies in adults have shown that delayed administration of appropriate antibiotics for severe infections and sepsis is strongly associated with poor outcome.2 If early vancomycin administration often reflected delayed administration of a ß-lactam antibiotic with better cerebrospinal penetration than vancomycin, that could account for the findings of the study.

REFERENCES

  1. Buckingham SC, McCullers JA, Luján-Zilbermann J, Knapp KM, Orman KL, English BK. Early vancomycin therapy and adverse outcomes in children with pneumococcal meningitis. Pediatrics. 2006;117 :1688 –1694[Abstract/Free Full Text]
  2. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34 :1589 –1596[CrossRef][ISI][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics




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