Doxycycline and Hearing Loss
Doxycycline does not cause ototoxicity and is not associated with hearing loss as an adverse effect. In fact, doxycycline has demonstrated protective effects against hearing loss in experimental models of bacterial meningitis and has been used successfully to treat otosyphilis with hearing improvement 1, 2.
Key Evidence Supporting Safety
Tetracyclines are not ototoxic agents: The comprehensive guidelines on ototoxic medications consistently identify aminoglycosides (streptomycin, amikacin, kanamycin), macrolides (erythromycin, azithromycin), and loop diuretics as the primary classes causing hearing loss, but tetracyclines including doxycycline are notably absent from these lists 3, 4, 5.
Doxycycline improved hearing in clinical studies: In a case series of 19 patients with otosyphilis and hearing loss treated with oral doxycycline 400 mg/day for 21 days, hearing improved in 47.3% of patients with no serious side effects reported 1.
Protective effects demonstrated: In experimental pneumococcal meningitis, doxycycline as adjuvant therapy significantly attenuated hearing loss and reduced neuronal death in the cochlear spiral ganglion, likely through its anti-inflammatory properties 2.
Contrast with Truly Ototoxic Antibiotics
The distinction between doxycycline and ototoxic antibiotics is critical:
Aminoglycosides cause irreversible hearing loss: Streptomycin, amikacin, and related drugs cause dose-dependent, permanent sensorineural hearing loss requiring baseline audiometry, monthly monitoring, and immediate discontinuation if ototoxicity develops 3, 4.
Macrolides cause reversible hearing loss: Erythromycin and azithromycin cause dose-dependent, reversible hearing loss that typically resolves within 6-14 days after discontinuation 3, 6.
Doxycycline requires no ototoxicity monitoring: Unlike aminoglycosides and macrolides, doxycycline does not require baseline audiometry, hearing assessments during treatment, or specific counseling about hearing loss risk 3.
Clinical Implications
When prescribing doxycycline for conditions like blepharitis, rosacea, or respiratory infections:
No hearing-related precautions needed: Standard side effect counseling should focus on photosensitivity, gastrointestinal upset, and contraindications in pregnancy and children under 8 years (due to tooth staining), not hearing loss 3.
Safe alternative to ototoxic agents: Doxycycline can be used without concern for ototoxicity in patients with pre-existing hearing loss, unlike aminoglycosides which are contraindicated or require extreme caution in this population 3, 7.
Common Pitfall to Avoid
Do not confuse tetracyclines with aminoglycosides or macrolides when counseling patients about ototoxicity risk. The evidence clearly demonstrates that doxycycline belongs to a different antibiotic class with an entirely different safety profile regarding hearing 3, 5.