Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis
Abstract The increased risk of hearing loss with macrolides remains controversial. We aimed to systematically review and meta-analyze data on the clinical risk of hearing loss, tinnitus, and ototoxicity following macrolide use. A systematic search was conducted across PubMed, MEDLINE, Cochrane, and...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2024-01-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-50774-1 |
| _version_ | 1797363467334713344 |
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| author | Sung Ryul Shim YungJin Lee Seung Min In Ki‐Il Lee Ikhee Kim Hyoyeon Jeong Jieun Shin Jong-Yeup Kim |
| author_facet | Sung Ryul Shim YungJin Lee Seung Min In Ki‐Il Lee Ikhee Kim Hyoyeon Jeong Jieun Shin Jong-Yeup Kim |
| author_sort | Sung Ryul Shim |
| collection | DOAJ |
| description | Abstract The increased risk of hearing loss with macrolides remains controversial. We aimed to systematically review and meta-analyze data on the clinical risk of hearing loss, tinnitus, and ototoxicity following macrolide use. A systematic search was conducted across PubMed, MEDLINE, Cochrane, and Embase databases from database inception to May 2023. Medical Subject Heading (MeSH) terms and text keywords were utilized, without any language restrictions. In addition to the electronic databases, two authors manually and independently searched for relevant studies in the US and European clinical trial registries and Google Scholar. Studies that involved (1) patients who had hearing loss, tinnitus, or ototoxicity after macrolide use, (2) intervention of use of macrolides such as azithromycin, clarithromycin, erythromycin, fidaxomicin, roxithromycin, spiramycin, and/or telithromycin, (3) comparisons with specified placebos or other antibiotics, (4) outcomes measured as odds ratio (OR), relative risk (RR), hazard ratio (HR), and mean difference for ototoxicity symptoms using randomized control trial (RCT)s and observational studies (case–control, cross-section, and cohort studies) were included. Data extraction was performed independently by two extractors, and a crosscheck was performed to identify any errors. ORs along with their corresponding 95% confidence intervals (CIs) were estimated using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines for RCTs and Meta-Analysis of Observational Studies in Epidemiology guidelines for observational studies were followed. We assessed the hearing loss risk after macrolide use versus controls (placebos and other antibiotics). Based on data from 13 studies including 1,142,021 patients (n = 267,546 for macrolide and n = 875,089 for controls), the overall pooled OR was 1.25 (95% CI 1.07–1.47). In subgroup analysis by study design, the ORs were 1.37 (95% CI 1.08–1.73) for RCTs and 1.33 (95% CI 1.24–1.43) for case–control studies, indicating that RCT and case–control study designs showed a statistically significant higher risk of hearing loss. The group with underlying diseases such as multiple infectious etiologies (OR, 1.16 [95% CI 0.96–1.41]) had a statistically significant lower risk than the group without (OR, 1.53 [95% CI 1.38–1.70] P = .013). The findings from this systematic review and meta-analysis suggest that macrolide antibiotics increase the risk of hearing loss and that healthcare professionals should carefully consider this factor while prescribing macrolides. |
| first_indexed | 2024-03-08T16:20:46Z |
| format | Article |
| id | doaj.art-c3fabbe01c3a44a3b88349e361bd00df |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-08T16:20:46Z |
| publishDate | 2024-01-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj.art-c3fabbe01c3a44a3b88349e361bd00df2024-01-07T12:22:37ZengNature PortfolioScientific Reports2045-23222024-01-0114111010.1038/s41598-023-50774-1Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysisSung Ryul Shim0YungJin Lee1Seung Min In2Ki‐Il Lee3Ikhee Kim4Hyoyeon Jeong5Jieun Shin6Jong-Yeup Kim7Department of Biomedical Informatics, College of Medicine, Konyang University Konyang Medical data Research group-KYMERA, Konyang University HospitalDepartment of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang UniversityDepartment of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang UniversityDepartment of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang UniversityDepartment of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang UniversityDepartment of Biomedical Informatics, College of Medicine, Konyang UniversityDepartment of Biomedical Informatics, College of Medicine, Konyang UniversityAbstract The increased risk of hearing loss with macrolides remains controversial. We aimed to systematically review and meta-analyze data on the clinical risk of hearing loss, tinnitus, and ototoxicity following macrolide use. A systematic search was conducted across PubMed, MEDLINE, Cochrane, and Embase databases from database inception to May 2023. Medical Subject Heading (MeSH) terms and text keywords were utilized, without any language restrictions. In addition to the electronic databases, two authors manually and independently searched for relevant studies in the US and European clinical trial registries and Google Scholar. Studies that involved (1) patients who had hearing loss, tinnitus, or ototoxicity after macrolide use, (2) intervention of use of macrolides such as azithromycin, clarithromycin, erythromycin, fidaxomicin, roxithromycin, spiramycin, and/or telithromycin, (3) comparisons with specified placebos or other antibiotics, (4) outcomes measured as odds ratio (OR), relative risk (RR), hazard ratio (HR), and mean difference for ototoxicity symptoms using randomized control trial (RCT)s and observational studies (case–control, cross-section, and cohort studies) were included. Data extraction was performed independently by two extractors, and a crosscheck was performed to identify any errors. ORs along with their corresponding 95% confidence intervals (CIs) were estimated using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines for RCTs and Meta-Analysis of Observational Studies in Epidemiology guidelines for observational studies were followed. We assessed the hearing loss risk after macrolide use versus controls (placebos and other antibiotics). Based on data from 13 studies including 1,142,021 patients (n = 267,546 for macrolide and n = 875,089 for controls), the overall pooled OR was 1.25 (95% CI 1.07–1.47). In subgroup analysis by study design, the ORs were 1.37 (95% CI 1.08–1.73) for RCTs and 1.33 (95% CI 1.24–1.43) for case–control studies, indicating that RCT and case–control study designs showed a statistically significant higher risk of hearing loss. The group with underlying diseases such as multiple infectious etiologies (OR, 1.16 [95% CI 0.96–1.41]) had a statistically significant lower risk than the group without (OR, 1.53 [95% CI 1.38–1.70] P = .013). The findings from this systematic review and meta-analysis suggest that macrolide antibiotics increase the risk of hearing loss and that healthcare professionals should carefully consider this factor while prescribing macrolides.https://doi.org/10.1038/s41598-023-50774-1 |
| spellingShingle | Sung Ryul Shim YungJin Lee Seung Min In Ki‐Il Lee Ikhee Kim Hyoyeon Jeong Jieun Shin Jong-Yeup Kim Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis Scientific Reports |
| title | Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis |
| title_full | Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis |
| title_fullStr | Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis |
| title_full_unstemmed | Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis |
| title_short | Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis |
| title_sort | increased risk of hearing loss associated with macrolide use a systematic review and meta analysis |
| url | https://doi.org/10.1038/s41598-023-50774-1 |
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