Doxycycline Does Not Cause Hearing Loss
Doxycycline is not an ototoxic medication and did not cause this patient's hearing loss. The hearing loss developed after hospitalization is almost certainly due to other factors, most likely exposure to truly ototoxic medications during the hospital stay (aminoglycosides, loop diuretics, or vancomycin) or other medical complications. 1
Why Doxycycline Is Not the Culprit
Tetracyclines, including doxycycline, are not identified as ototoxic agents by comprehensive guidelines from the American Thoracic Society, which instead highlight aminoglycosides, macrolides, and loop diuretics as the primary classes causing hearing loss. 1
No hearing-related precautions are required when prescribing doxycycline, and standard side effect counseling focuses on photosensitivity and gastrointestinal upset—not hearing loss. 1
Doxycycline can be safely used as an alternative to ototoxic agents in patients with pre-existing hearing loss, without concern for ototoxicity. 1
The known adverse effects of doxycycline include photosensitivity and gastrointestinal disturbances, but hearing loss is not listed among tetracycline-class adverse events. 2
What Actually Causes Hearing Loss in Hospitalized Patients
Aminoglycosides (Most Likely Culprit)
Aminoglycosides cause dose-dependent, permanent sensorineural hearing loss that requires baseline audiometry and monthly monitoring during treatment. 1, 3
Common culprits include gentamicin, tobramycin, amikacin, and streptomycin—frequently used in hospitalized patients for serious infections. 2
Ototoxicity from aminoglycosides is irreversible, and the risk increases with older age (this patient is 69), duration of treatment, and cumulative dose. 2
Loop Diuretics
- Furosemide (Lasix) and other loop diuretics are well-established ototoxins, particularly when used in high doses or combined with aminoglycosides. 2, 4
Macrolides
- Azithromycin and erythromycin cause dose-dependent hearing loss, particularly in elderly patients, though this is typically reversible within 6-14 days after discontinuation. 2, 1
Critical Investigation Steps
Review the hospital medication administration record for:
- Any aminoglycoside antibiotics (gentamicin, tobramycin, amikacin, streptomycin) 2, 3
- Loop diuretics (furosemide/Lasix) 2, 4
- Macrolide antibiotics (azithromycin, erythromycin) 2, 1
- Vancomycin or other nephrotoxic/ototoxic agents 3
Assess for other hospital-related risk factors:
- Renal impairment during hospitalization (dramatically increases aminoglycoside ototoxicity risk) 3, 5
- Combination of multiple ototoxic medications 3, 5
- Prolonged ICU stay with exposure to multiple antibiotics 2
Common Pitfall to Avoid
Do not attribute hearing loss to doxycycline simply because it was prescribed around the time symptoms developed. Temporal association does not equal causation, and doxycycline has no established mechanism for causing ototoxicity. 1 The true culprit is almost certainly a genuinely ototoxic medication administered during hospitalization, and identifying it is crucial for preventing further damage and guiding future treatment decisions. 3, 5