1. Patients under 18 years of age with sensorineural hearing loss (SNHL) had a higher odds of exposure to macrolides than penicillin, compared to those without SNHL.
2. For patients with SNHL, there was a higher odds of macrolide use compared to penicillin use in the period 181-365 days prior to SNHL diagnosis.
Evidence Rating Level: 3 (Average)
Macrolides are common antibiotics prescribed for children and young adults, with 50% of otitis media and 8-16% of respiratory infections managed with outpatient macrolides. However, some case reports and case series have identified associations between sensorineural hearing loss (SNHL) with macrolide use in adults, for those with comorbid conditions or receiving intravenous/high dosing. As well, a case series in children found a 7% prevalence of SNHL for long-term macrolide use in treating non-TB mycobacteria. Therefore, this current case-control study examined the odds of exposure to oral outpatient macrolide therapy, with penicillin therapy as the control exposure, for SNHL and non-SNHL patients 0-18 years of age. The study population consisted of 875 cases with SNHL and 875 controls without SNHL, matched 1:1 by age group, sex, and months since prescription. The mean (SD) age was 5.7 (4.9) years, and the most common duration of macrolide use was 5 days (79% of macrolide patients). The results showed that patients with SNHL had a higher odds of exposure to macrolides than penicillin, compared to those without SNHL (adjusted odds ratio 1.31, 95% CI 1.05-1.64). Additionally, there was no difference in odds of macrolide or penicillin exposure 0-180 days prior to SNHL diagnosis, but there was a significant difference when exposure occurred 181 to 365 days prior to SNHL diagnosis, with odds of macrolide exposure being higher (adjusted OR 1.79, 95% CI 1.23-2.60). Overall, this study demonstrated that further studies are needed to elucidate the association between macrolides and SNHL, as children and adolescents with SNHL had a higher odds of exposure to macrolides compared to penicillin.
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