by Neil Bauman, Ph.D.
February 19, 2016
A man explained,
I have profound sensorineural hearing loss and don’t want to lose any more hearing because that could change my life! I have been diagnosed with prostatitis (prostate infection) and I showed my doctor your book. We decided against Tetracycline (class 3) in favor of Bactrim, a combination of Trimethoprim (class 1) and Sulfamethoxazole (class 2). Do you agree with this? Also, is it better to take one pill morning and night for three weeks, or two pills morning and night for two weeks? Thank you so much for your expert insight!
You are doing a wise thing—taking my book, “Ototoxic Drugs Exposed” with you to your doctor and then the two of you working together to choose the least ototoxic drug that will do the job. That way you can best protect your precious remaining hearing.
You narrowed the choices down to two drugs, and then chose the one with the lesser ototoxicity. If these were your only two choices, I think you have made the better choice.
However, I think you could have made an even better choice if you had considered other drugs in the same class as Trimethoprim (Bactrim). You’ll notice that Trimethoprim is in a class of drugs called Urinary Anti-infectives (7.20).
If you turn to Table 14-1, and classification 7.20 you’ll see that there are four drugs listed. Did you and your doctor consider each of the choices there?
In addition to Trimethoprim, Nitrofurantoin (MacroBID) is also listed there. Notice that it does not have any cochlear side effects (such as tinnitus, hyperacusis or hearing loss) listed.
Since you don’t want to mess up any of your remaining hearing, given the choice, I’d stay away from any drug that has any cochlear side effects.
As you know, Bactrim is a combination of two drugs—Trimethoprim (which also does not have any cochlear side effects) and Sulfamethoxazole (which has tinnitus listed as a cochlear side effect).
Thus Bactrim has a slight chance of giving you tinnitus, whereas taking Nitrofurantoin doesn’t. Thus, if given the choice, taking Nitrofurantoin would be an even better choice from your ears point of view if your doctor thinks it will be as effective as the Bactrim.
It’s always wise to check out as many choices as you can to find the least ototoxic drug that will do the job.
Now to answer your question on the two dosage options—an excellent question by the way. Here’s some guidelines to help you choose wisely.
I have three guidelines when it comes to taking drugs.
- Take the least ototoxic drug.
- Take the lowest dose possible.
- Take it for the shortest effective time.
Above, we considered point 1. Now lets look at points 2 and 3.
Your options were:
- take 1 pill twice a day for 3 weeks. The total would be 2 x 21 days = 42 pills in total.
- take 2 pills twice a day for 2 weeks. The total would be 4 x 14 days = 56 pills in total.
Therefore, for point 2, the lowest dose would be the first one above—taking 42 pills. This would give you a lower cumulative dose, which should be less ototoxic.
Although this option gives the lower total dose, it spreads it out over a longer time. This flies in the face of my point 3 guideline—take if for the shortest time possible. Here’s how I rationalize between these two conflicting options.
Very often drugs have what I call a “magic threshold” in terms of dose below which you don’t have any noticeable ototoxic side effects. (I call it a “magic threshold” because you don’t know what that dosage level is below which you don’t have ototoxic side effects. Furthermore, this dose may be different for each person.) Thus, taking a lower dose (1 pill at a time rather than 2 pills at a time) means that you have a much better chance of flying below the radar of this magic threshold—whatever level it is.
At the same time, you are stretching out the dose over 3 weeks instead of 2, but you are taking a lower cumulative dose—so I think those two factors balance each other out.
Thus, if it were me, I’d choose the first option and take 1 pill twice a day for 3 weeks and hope no ototoxic side effects (or any other side effects for that matter) would show up.