1161
city due to erythromycin is the result of very high blood levels. Physicians should be aware of this complication, since it cannot be assumed that the auditory impairment will always be reversible. Division of Virology, Bureau of Biologics, Food and Drug Administration, Bethesda, Maryland 20014, U.S.A.
GERALD V.
QUINNAN, JR
Laboratory of Infectious Diseases, Boston City Hospital,
WILLIAM R. MCCABE
Boston, Massachusetts
OTOTOXICITY OF GENTAMICIN EAR-DROPS et al.’ instilled 0-3% gentamicin solution dithe middle ear of guineapigs daily for thirteen days and then studied histology of the vestibular and cochlear hair cells. They reported "severe changes ... similar to the degeneration observed after intramuscular injections of high doses of gentamicin given over a long period". I was surprised by this report because I have seen several children prescribed gentamicin drops for discharging ears. I wondered if this was a mistaken use of the drug, but the 1978 data sheet2 for "Gentisone HC" ear drops (0.3% gentamicin and 1% hydrocortisone) includes chronic suppurative otitis media under "uses", and under "contra-indications, warnings, etc" states: "No special precautions are indicated". Can anyone explain this apparent contradiction?
SIR,-Wersall
rectly into
of Pædiatrics and Neonatal Medicine, Institute of Child Health, Hammersmith Hospital, London W12 0HS
Department
R. A. K. JONES
GALACTOKINASE AND CATARACTS
SIR,-Dr Prchal and colleagues (Jan. 7, p. 12) found that of 12 patients with juvenile cataracts 5 had red-blood-cell (R.B.c.)
galactokinase levels pointed out, in 1973
"heterozygous" range. As they we reported the galactokinase activities of in the
210 patients with cataracts,
genital
cataracts or
including 106 patients with concataracts arising in the first year of life.3
Since then we have done assays on a further 187 unrelated patients with cataracts, 107 of which were congenital or arising
in infancy. A modest association between lowered R.B.C. galactokinase activity and cataracts, confirmed by Kaloud et al. but not by Harley et al.,s is strengthened by the enlarged data. The figure shows the distribution of galactokinase activities for 134 White patients who were over the age of four, but who had had cataracts at birth or before their first birthday. It is important to limit observations to persons over four years old to avoid the bias which would be introduced by the higher galactokinase levels which are normally observed in young children. Since Blacks have a low galactokinase polymorphism, they too must be excluded from analysis. Galactokinase values between 1 and 20 mU/g Hb were more common in patients with cataracts than in controls (X2=5.3; P-0-02), but our data do not confirm the striking frequency of low galactokinase activities reported in the small sample of Prchal et al. 3 patients with total galactokinase deficiency were observed among the 213 persons (including all ages at the time of examination and all races) who had congenital cataracts or cataracts arising in the first year of life, a frequency of 1 -4%. This 1. Wersall, J., Lundquist, P. G., Bjorkroth, B. J. infect. Dis. 1969, 119, 410. 2. Data Sheet Compendium 1978. London. 3. Beutler, E., Matsumoto, F., Kuhl, W., Krill, A., Levy, N., Sparkes, R., Degnan, M. NewEngl. J. Med. 1973, 288, 1203. F. 4. Kaloud, H., Sitzmann, C., Schenker, H., Prestele, H. Dt. med. Wschr.
1975, 100, 873. 5.
Harley, J. D., Mutton, P., Irvine, S., Gupta, J. D.Lancet, 1974, ii, 259.
Galactokinase activities of the red cells of 134 patients with congenital cataracts or cataracts arising in the first year of life and of 150 normal controls. All subjects are White and were over the age of 4 years when tested. The shaded portion of the bars represents data previously reported.’1 The open portion depicts data accumulated since 1973.
frequency is unlikely to be due to chance (p
city due to erythromycin is the result of very high blood levels. Physicians should be aware of this complication, since it cannot be assumed that the auditory impairment will always be reversible. Division of Virology, Bureau of Biologics, Food and Drug Administration, Bethesda, Maryland 20014, U.S.A.
GERALD V.
QUINNAN, JR
Laboratory of Infectious Diseases, Boston City Hospital,
WILLIAM R. MCCABE
Boston, Massachusetts
OTOTOXICITY OF GENTAMICIN EAR-DROPS et al.’ instilled 0-3% gentamicin solution dithe middle ear of guineapigs daily for thirteen days and then studied histology of the vestibular and cochlear hair cells. They reported "severe changes ... similar to the degeneration observed after intramuscular injections of high doses of gentamicin given over a long period". I was surprised by this report because I have seen several children prescribed gentamicin drops for discharging ears. I wondered if this was a mistaken use of the drug, but the 1978 data sheet2 for "Gentisone HC" ear drops (0.3% gentamicin and 1% hydrocortisone) includes chronic suppurative otitis media under "uses", and under "contra-indications, warnings, etc" states: "No special precautions are indicated". Can anyone explain this apparent contradiction?
SIR,-Wersall
rectly into
of Pædiatrics and Neonatal Medicine, Institute of Child Health, Hammersmith Hospital, London W12 0HS
Department
R. A. K. JONES
GALACTOKINASE AND CATARACTS
SIR,-Dr Prchal and colleagues (Jan. 7, p. 12) found that of 12 patients with juvenile cataracts 5 had red-blood-cell (R.B.c.)
galactokinase levels pointed out, in 1973
"heterozygous" range. As they we reported the galactokinase activities of in the
210 patients with cataracts,
genital
cataracts or
including 106 patients with concataracts arising in the first year of life.3
Since then we have done assays on a further 187 unrelated patients with cataracts, 107 of which were congenital or arising
in infancy. A modest association between lowered R.B.C. galactokinase activity and cataracts, confirmed by Kaloud et al. but not by Harley et al.,s is strengthened by the enlarged data. The figure shows the distribution of galactokinase activities for 134 White patients who were over the age of four, but who had had cataracts at birth or before their first birthday. It is important to limit observations to persons over four years old to avoid the bias which would be introduced by the higher galactokinase levels which are normally observed in young children. Since Blacks have a low galactokinase polymorphism, they too must be excluded from analysis. Galactokinase values between 1 and 20 mU/g Hb were more common in patients with cataracts than in controls (X2=5.3; P-0-02), but our data do not confirm the striking frequency of low galactokinase activities reported in the small sample of Prchal et al. 3 patients with total galactokinase deficiency were observed among the 213 persons (including all ages at the time of examination and all races) who had congenital cataracts or cataracts arising in the first year of life, a frequency of 1 -4%. This 1. Wersall, J., Lundquist, P. G., Bjorkroth, B. J. infect. Dis. 1969, 119, 410. 2. Data Sheet Compendium 1978. London. 3. Beutler, E., Matsumoto, F., Kuhl, W., Krill, A., Levy, N., Sparkes, R., Degnan, M. NewEngl. J. Med. 1973, 288, 1203. F. 4. Kaloud, H., Sitzmann, C., Schenker, H., Prestele, H. Dt. med. Wschr.
1975, 100, 873. 5.
Harley, J. D., Mutton, P., Irvine, S., Gupta, J. D.Lancet, 1974, ii, 259.
Galactokinase activities of the red cells of 134 patients with congenital cataracts or cataracts arising in the first year of life and of 150 normal controls. All subjects are White and were over the age of 4 years when tested. The shaded portion of the bars represents data previously reported.’1 The open portion depicts data accumulated since 1973.
frequency is unlikely to be due to chance (p
