Background
Multi-drug resistant Tuberculosis (MDR TB) represents approximately 5.7% of TB Worldwide. Prior to the advent of Bedaquiline in 2019, iv aminoglycosides were a mainstay of treatment for MDR TB.
 
Methods
This  study is a 15 year retrospective cohort study of all patients treated with IV aminoglycosides for MDR TB analysed the effect of these aminoglycosides on hearing loss and renal function in a National TB Referral Centre.
 
Results
Over this time period, 26 patients were treated with IV amikacin for MDR TB. All patients had pre-and post-treatment audiology performed. 17 of these patients had subjective hearing loss, with 18 patients having confirmed objective hearing loss on audiology, and 19 patients reported tinnitus. A higher risk of developing objective hearing loss was seen in patients who were treated for longer durations with IV amikacin. Over half of all patients showed an increase in their creatinine of more than 10% above their pre-treatment baseline.
 
While there was an association between duration of amikacin treatment and objective hearing loss, this was not statistically significant, once adjusted for confounders including age and gender.

Conclusion
This study illustrates the high prevalence of hearing loss in patients with MDR TB prior to the advent of Bedaquiline, with both hearing loss and tinnitus causing significant burden of patient symptoms. Current, entirely oral based, MDR TB regimens are not associated with this risk.