From the Guidelines
Doxycycline is not commonly associated with ototoxicity, but it can rarely cause this side effect, as evidenced by the lack of mention in the British Thoracic Society guideline for bronchiectasis in adults 1. The guideline focuses on the treatment of various infections, including those caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, and recommends doxycycline as a second-line treatment for some of these infections. However, it does not mention ototoxicity as a potential side effect of doxycycline. In contrast, the guideline does highlight the risk of ototoxicity associated with aminoglycosides, such as gentamicin and tobramycin, which are used to treat Pseudomonas aeruginosa infections 1. According to another study, minocycline, a related antibiotic, has been associated with tinnitus, dizziness, and pigment deposition of the skin, mucous membranes, and teeth 1. However, doxycycline is primarily metabolized by the liver and can be used safely in most patients with renal impairment, which reduces the risk of ototoxicity compared to other antibiotics 1. Some key points to consider when prescribing doxycycline include:
- Monitoring for early symptoms of ototoxicity, such as ringing in the ears, hearing changes, or dizziness
- Being aware of risk factors that might increase the chance of ototoxicity, including high doses, prolonged treatment courses, pre-existing hearing problems, advanced age, and concurrent use of other ototoxic medications
- Considering alternative treatments for patients with a history of ototoxicity or those who are at high risk of developing this side effect.
From the Research
Ototoxicity of Doxycycline
- The available evidence does not directly link doxycycline to ototoxicity in the majority of the studies reviewed 2, 3, 4, 5.
- However, one study suggests that doxycycline may be associated with ototoxicity, although this is not a widely reported side effect 6.
- Doxycycline is a tetracycline antibiotic, and while tetracyclines are not typically known for their ototoxic potential, there is some evidence to suggest that they may cause hearing loss or other auditory problems in certain cases 5, 6.
- The study that reported ototoxicity as a potential side effect of doxycycline used data from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, which may not be comprehensive or definitive 6.
- Further research is needed to fully understand the potential risks of ototoxicity associated with doxycycline and other tetracycline antibiotics 3, 5, 6.
Comparison with Other Antibiotics
- Aminoglycoside antibiotics are well-known for their ototoxic potential, but doxycycline is not typically classified as an aminoglycoside 2, 3, 5.
- Other non-aminoglycoside antibiotics, such as macrolides and vancomycin, have been associated with ototoxicity in certain cases 5.
- The available evidence suggests that doxycycline may be a safer alternative to other antibiotics in terms of ototoxicity risk, but more research is needed to confirm this 4, 6.
Clinical Implications
- Healthcare providers should be aware of the potential risks of ototoxicity associated with doxycycline and other antibiotics, although the current evidence suggests that doxycycline is not typically ototoxic 3, 6.
- Patients taking doxycycline or other antibiotics should be monitored for signs of ototoxicity, such as hearing loss or tinnitus, and report any concerns to their healthcare provider 2, 3, 5.