Ototoxicity--which can occur via both auditory and vestibular mechanisms--is one of the major side effects of aminoglycoside use, particularly in dialysis patients. A recent paper looked at N-acetyl cysteine (NAC) as a potential strategy for preventing ototoxicity in dialysis patients.
In this study, HD patients who were being treated for catheter-associated bacteremia were randomly assigned to either 600mg of NAC versus placebo. Of the 40 patients who received gentamicin for > 2 weeks, those who received NAC had a 42% reduction in ototoxicity as assessed by serial audiometric evaluations.
Given the relatively low cost and low side effect profile of NAC, it seems reasonable to use this strategy for preventing aminoglycoside-induced ototoxicity. Of note, NAC has proved to be quite a versatile drug--already being used as a mucolytic agent, a drug which allegedly prevents nephrotoxic injury from iv contrast, and as an invaluable tool for treating Tylenol overdose.