by Neil Bauman, Ph.D.
In order to avoid (as much as is possible) the ototoxic (ear damaging) side effects from taking drugs, for years I have suggested that you:
- Take the least ototoxic drug that will do the job
- Take the lowest effective dose
- Take it for the shortest time possible
By doing this you will reduce your risk of suffering damage to your ears. However, as I’ve said many times before, you also have to consider all the other possible side effects that may affect the rest of your body.
For example, the Cephalosporin class of antibiotics is one of the least ototoxic classes of antibiotics. As a result, if you need to take an antibiotic and want to reduce your risk of ear damage, it seems like a good choice. And indeed, I have made such suggestions to various people.
However, a recent study revealed that you still have to be careful. Just taking a single course of a Cephalosporin antibiotic can increase your risk of getting type II diabetes by 9%. (1) And taking more than one course of these antibiotics in the same year can greatly increase that risk. (Note: Cephalosporin antibiotics include drugs such as Cefaclor, Cefadroxil, Cefazolin, Cefpodoxime, Cefprozil, Ceftriaxone, Cefuroxime and Cephalexin.)
Here are two other examples from this same study. Taking two to five courses of penicillin (a mildly ototoxic drug) in a single year raised the risk of getting diabetes by 8%, while taking more than five courses in a year raised the risk by 23%. (1)
Taking 2 to 5 courses of a fairly ototoxic class of antibiotics called the Fluoroquinolone antibiotics raised the risk of getting diabetes by 15%, while taking more than five courses raised the risk by 37%. (1) (Fluoroquinolone antibiotics include drugs such as Cinoxacin, Ciprofloxacin, Enoxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Levofloxacin, Lomefloxacin, Moxifloxacin, Norfloxacin, Ofloxacin, Sparfloxacin and Trovafloxacin.)
Therefore, you need to remember that there are always trade-offs. People contact me to help them find the least ototoxic drug they can take for a given condition-—and I give them some suggestions—but I warn them that they need to check out all the other side effects as well–before they decide which drug they ultimately will take. You would be wise to do the same.
If you want to look up the ototoxic side effects of Bupropion (Wellbutrin), see my book “Ototoxic Drugs Exposed” 3rd edition. This book contains information on the ototoxicity of 877 drugs, 35 herbs and 148 chemicals.
________
(1) Yang, Yu-Xiao. Could Antibiotics Give You Diabetes? June 11, 2015. Bottom Line Health. http://bottomlinehealth.com/could-antibiotics-give-you-diabetes/.
Ancef 1 gram will be probably given me IV for hernia surgery. Already have tinnitus and have had hearing problems in past – Went away but my environment is very noisy unfortunately and tinnitus now is back. Will this severely affect my hearing (the one dose of cephalosporin during surgery)?
Hi Donna:
Cefazolin (Ancef) is not listed as causing hearing loss or tinnitus according to my information. Therefore, it is highly unlikely that taking one dose of it for your surgery is going to affect your tinnitus or your hearing for that matter.
As a whole, the Cephalosporin class of antibiotics are less ototoxic than most other classes of antibiotics. And Cefazolin is one of the least ototoxic of the Cephalosporin class, so Ancef appears to be a good choice.
Cordially,
Neil
Dear Dr. Bauman,
I see you wrote this reply regarding Cefazolin in 2017 and wanted to ask if you have encountered any reports of Cefazolin being ototoxic since then? It seems like there aren’t reports of ototoxicty and this drug but since things can change in four years I wanted to check in with you about it, as I’m scheduled to have surgery and Ancef/Cefazolin will be administered.
I also wanted to ask your opinion on the local anesthetic Exparel/Bupivicaine (https://www.exparel.com/patient/faq). The doctor plans to use this as a numbing agent that lasts up to 3 days post-operation. I would rather be in excruciating pain than have worse tinnitus (and just take a low dose of Tylenol if I have to) so I was going to ask the doctor to skip this local anesthetic if the risk that it may worsen my tinnitus is significant. What is your opinion on this drug’s potential to be ototoxic?
Thank you as always,
Steph
Hi Steph:
I seem to have missed answering you. I know I’m too late, but here goes anyway for your future reference.
Yes, I’ve found out more about the ototoxicity of Cefazolin (Ancef). The good news is that Cefazolin is only mildly ototoxic, so most people won’t experience any ototoxic side effects. But it can still cause tinnitus and hearing loss (among other things) for some people so caution is always warranted until you know it won’t cause you any problems.
Bupivacaine (Exparel) is also only very mildly ototoxic so again is a good choice.
I hope everything worked well for you.
Cordially,
Neil
Hey Doc, How do you feel about cefdinir? It’s in the same family and it was prescribed to me after a septoplasty today. I’m a little terrified about taking pills in general, anymore due to the possibility of worsening tinnitus.
Thanks,
Dillon
Hi Dillon:
Based on the information I have, Cefdinir is only mildly ototoxic. Thus, I doubt it will give you tinnitus or make any existing tinnitus worse. So it appears to be a good choice, but as always there are no guarantees. But I believe the risk of tinnitus from this drug is very low.
Cordially,
Neil
First, thank you for posting such useful information! I’ll be looking into your book. Second, I have to take antibiotics for neuroborreliosis, and options are 1) Doxycycline 200mg for 14 days or 2) IV Ceftriaxone for 14 days. I’m concerned about Doxycycline, but is IV Ceftriaxone less ototoxic?
Hi Guillaume:
Ceftriaxone has less than half the ototoxic reports as compared to Doxycycline so it would seem it would be the better choice–but still both of these drugs are ototoxic to some degree so there are no guarantees you won’t have any ototoxic side effects. But I think the odds are more in your favor with the Ceftriaxone.
Cordially,
Neil
Thanks for your input Neil! Seems like all the signs point to Cephalosporins are least ototoxic antibiotic family. I wonder if IV vs. oral route makes a difference as well.
What antiobiotics should I ask for if I have tinnitus and need oral surgery?
Please I wanna ask a question, this Happened to me last year when this buzzing started in my ear, before I came across tinnitus I got some kind of blockage in my ear unfortunately I went to consult a doctor, she prescribed cenfuroxime I used it, and the blockage was gone but I later realized that I now got some kind of buzzing in my ear, didn’t stopped, still now
Hi Farouq:
It is possible that you got the tinnitus from taking the Cefuroxime. Some people have–but as near as I can tell, it’s not very common. But you could have been one of the unlucky ones.
You could also have the tinnitus from some residual hearing loss. Very often tinnitus accompanies hearing loss (whether you are even aware of the hearing loss or not).
Those seem to be the most likely causes of your tinnitus.
Cordially,
Neil
Hello Mr. Neil
I used cefuroxime sold as xorimax for 4 days, twice a day and I got tinnitus even before I finish them on the 5th day. What are chances that the drug is the cause of my T.? What is the most non ototoxic antibiotics? Thank you
Hi Zoran:
There have only been a few reports of Cefuroxime causing tinnitus. You could be one of the unlucky ones, or your tinnitus may have been caused by another drug, or in combination with another drug if you are taking more than one.
The least ototoxic antibiotic needs to be able to do the job–so I’d have to know what classes of antibiotics would do the job–then I could suggest what I feel are the least ototoxic in that class or classes.
Cordially,
Neil
Hi Dr. Bauman,
I get acute bronchitis about 4 x a year- I spend 2 mos of every year sick. I get whenever I get a cold. And I almost always get colds if a coworker comes in with one. My immune system tests as “normal” but my doctor wants to try me on a low dose of prophylactic Azithromycin. I’ve taken Az before with no protocol effects, but I’ve developed mild tinnitus which comes and goes from another drug. (No one believes me but I’m convinced it was Linzess). So what are your thoughts on the risks of taking low dose AZ.?
Hi Martha:
I’m not a medical doctor, but your immune system is definitely NOT healthy and robust. The proof is that you keep on getting colds and bronchitis time after time. I don’t care that it tested “normal”–whatever that means.
I’m assuming that each time you get sick, your doctor prescribes more antibiotics–right? And each time you take antibiotics you weaken your immune system since around 80% of your immune system is related to the micro-flora and fauna in your gut. Antibiotics kill them off leaving you wide open to other opportunistic infections. That is why you always want to be taking live culture yogurt or other fermented foods during and after a course of antibiotics. Or, at second best, taking adequate probiotics to get your gut flora up to snuff again.
In your case, it is probably a good idea to eat live culture foods daily from now on.
I am totally against taking any antibiotics prophylactically–meaning “just in case it will help”. It may help in one sense, but, at the same time, it WILL also cause more damage to your immune system and thus you health will not improve, but tend to get worse as the years go by.
I’ll also bet your vitamin D3 levels are low. “Normal” is anything over about 20 ng/ml, yet the healthy level is way up between 60 and 80 ng/ml. My goal is to keep mine around 70 ng/ml. You might want to do the same.
Now to answer you question about tinnitus. A low dose of Azithromycin probably won’t cause tinnitus since you have taken in before without any resulting tinnitus–but as always, there are no guarantees.
As for Linaclotide (Linzess) causing tinnitus, I have no information on that. So you may be correct (or not). I can’t say until I find more information.
Cordially,
Neil
Hi Mr. Niel
I screwed up taking a course of amoxicilin for a middle ear infection and it came back 3 days later. My doctor prescribed cefprozil but I’m concerned about doing two antibiotics in a row. I already have quite a bit of tinitus. Will cefprozil damage my hearing significantly? Should I try to find another option? Thank you
Hi Igor:
My information is that Cefprozil is much less ototoxic than Amoxicillin, so should be a good choice for not causing problems with your tinnitus (or hearing for that matter).
Cordially,
Neil
Hello, is 500 mg of penicillin 3 times a day going to damage my ears or make them ring? I haven’t had antibiotic in years.
Hi BM:
First off, I don’t deal in doses as such because everyone is different so maybe that dose won’t affect you but affects someone else or vice versa. So I can’t answer your question. What I can tell you is that Penicillin is mildly ototoxic and does cause hearing loss and tinnitus in some people taking it. I really don’t know whether it will affect you or not–but the risk is there.
My rules of thumb state that you take the least ototoxic drug that will do the job (and penicillin is “down there somewhere”, you take the smallest dose that will do the job (I don’t know if 1.500 mg a day is the smallest dose that will do the job), and you take it for the shortest time that will do the job. When you do this you have a good chance of flying under the ototoxic radar and won’t have any obvious side effects. But even so, there are no guarantees.
Cordially,
Neil
Is cefpodoxime proxetil 200 me cause tintinus . 2 month before my ear drum was perforted my Dr prescribed me this medicine for 10 days afterwards I am feeling ringing in my ears please Dr neil solve my problem what should I do
Hi Rajdeep:
Cefpodoxime (Proxetil) is very mildly ototoxic according to my information. I would not expect it to cause tinnitus, except in rare cases. It’s possible this drug caused your tinnitus, but it could be from other causes such as your perforated eardrum, or even anxiety, or noise exposure, etc.
In any case, no matter how it happened, treatment for tinnitus is similar. If your tinnitus is not too bad, realize that it is NOT a threat to your well-being–so treat it the same way you deal with any unimportant background sound. You ignore such sounds, so do the same with your tinnitus. In time it will fade into the background, just like those other background sounds.
However, if you focus on your tinnitus, the opposite will happen. Your brain will consider them to be important sounds and will thus make them louder and more intrusive.
If you have trouble sleeping or getting to sleep because of your tinnitus, turning a fan on often help many people, or listen to a CD of environmental sounds. Most people find a water sound–waves on the beach, waterfall sounds, water in a creek, or rainfall sounds a good sound to listen to during the night.
See how these suggestions work for you.
Cordially,
Neil
Is tinnitus fully cured if I ignored it and try to live normally or have any other treatment .will you suggest me what type of treatment should I take
Hi Rajdeep:
Tinnitus may not go away completely, but it can fade into the background so you are not aware of it for hours at a time, and even when you do hear it, it doesn’t bother you so it makes no difference whether it is there or not. This is called becoming habituated to your tinnitus. This is success. I am so habituated to my tinnitus that I seldom am aware of it although it is there all the time. Like right now, answering this comment, my tinnitus is ringing away–but it is not bothering me or affecting my quality of life. But here’s some better news–within five minutes of completing this comment and going on to something that does not involve thinking about tinnitus, I won’t even know I have tinnitus. You can do the same. But this will only happen if you do NOT treat your tinnitus as a threat to your well-being in any way, but treat it as you would any other totally unimportant noise and ignore it.
Cordially,
Neil
I am suffuring from tinnitus from last 20 december all on a sudden after I took benzodiazepin & cefuroxim simultaneously,, Before that I used to hear sound in my left ear just during crying,, so my doc prescribed me cefuroxim, rupantadin, oxydrops nasal drop,,and as far as I started to t ke the medicine,,,I felt tinnitus,,,but still I complete my drug dose & now I am suffuring from tinnitus for last 2months,,,
What should I do now?
Hi Fatima:
Are you still taking any drugs now?
My guess is that the benzodiazepine was the culprit that caused your tinnitus rather than the Cefuroxime.
There are no guaranteed cures for drug-induced tinnitus, but numbers of people find that taking a therapeutic dose of ginkgo biloba really helps them. You want to make sure the formulation you takes has the proper dose of the active ingredients. The one that I suggest, because it does exactly that is Arches Tinnitus Formula. You can get it on the internet at https://www.tinnitusformula.com/store/arches-tinnitus-formula/
Get a three month supply and at the end of 3 months, evaluate how your tinnitus is doing then.
Cordially,
Neil
Hi Fatima:
Are you still taking any drugs? If they are causing your tinnitus, I’d get off them if you can. Once you are drug-free, then you need to begin a program to help you successfully deal with your tinnitus. There are a number of things you can do to bring your tinnitus under your control. I’d suggest a counselor versed in Cognitive Behavioral therapy in relation to tinnitus as an excellent place to start.
Cordially,
Neil
Hi Rajasheep. I have same story cefpodoxmin for 5 days (two tablets daily coused my tinittus
Sir how is your situation now same thing happened to me
Hi rajdeep can you give your contact I have same situations
Dear Dr Neil,
I have had a case of Tinnitus caused from loud music a number of years back and it took about a year for it to fade out but it more or less completely went away. I noticed however that it comes back much easier if I spend time unprotected in loud environments (like a bar with loud music) but then so far has faded away. It has all been good for a few years until this week.
I have just now needed to start on an antibiotic treatment and my GP initially prescribed Ciprofloaxin which kicked off the tinnitus again at moderate loudness.
We talked about it and he switched to another drug called Zinnat that is supposedly much less ototoxic but the ringing is till there and rather increasing in intensity as I take further doses (up to 4 doses of the Zinnat at the moment and 1 dose of Cipro).
The GP recommends powering through the treatment and hoping that the tinnitus fades away but I am concerned that it will remain permanently at these higher levels…
Not sure if you could give a recommendation, would the risk for permanent tinnitus increase depending on how long I take the drug or is the potential damage already so to say done?
Also should I expect ever worsening tinnitus for any subsequent antibiotic treatments?
I was originally prescribed the cipro for 10 days (2* 500 mg per day) and the Zinnat for 7 days also (2*500 mg)
Would be extremely grateful for any help or advice that you could give.
Hi Daniel:
The more you expose your ears to loud sounds, the more damage that causes and thus each time you do this, you don’t have to expose your ears to as loud sounds or for as long a time before your tinnitus comes back. And eventually, it will never go away. So you want to protect your ears NOW so things don’t continue to get worse.
Ciprofloxacin is a good drug to stay away from–unless it is a matter of life and death. It is quite ototoxic. I hear from many people that have damaged their ears from taking it.
In contrast, Cefuroxime (Zinnat) is much less ototoxic–so of the two drugs this one would be my choice.
Why do you have to take the Cipro (which seems to be damaging your ears) when you are taking the Zinnat?
I’m with you about NOT “powering through” as it is YOUR ears that will have the permanent tinnitus, not your doctors.
It’s hard to say whether you tinnitus will go away or drop to a low level when you stop the Cipro (and Zinnat) It may, or may not.
Obviously your ears are sensitive to the Fluoroquinolones of which Cipro is one. So that would be a good class of drug to stay away from if at all possible. I’d take cephalosporins instead such as Zinnat as they are much less ototoxic.
Your ears may not be sensitive to all antibiotics, so choose the lesser ototoxic ones in the future–ones that only have a few reports of tinnitus. That puts the odds in your favor.
Another thing. My policy is only to take antibiotics for as long as I have symptoms plus 1 more day–not take the full prescription the doctor gives. This also puts the odds more in your favor. It used to be that doctors said you needed to take the full dose or else antibiotic resistance would build up. I read a more recent publication that now shows just the opposite.. that you should NOT take the full dose–just take it for as long as is necessary to bring the infection under control.
I practice what I preach. I picked up an infection that I couldn’t shake so right now am on the 2nd day of a 7 day course. I’m hoping that the infection will clear up by day 3 and I’ll stop on day 4 if that happens. That’s what happened a previous time so I’ll try it again this time.
Cordially,
Neil
Dear Dr Niel,
Many thanks for your reply!
Just to clarify that when I notified my GP of the Tinnitus starting from the Cipro he told me to stop that at once and prescribed in stead the Zinnat instead so I am not taking both the antibiotics, just the Zinnat now.
I’m on day 2 of a 7 day prescription and the GP suggested doing at least 5 days of the cure but then I shall hope that the symptoms (of a likely testicular infection) have passed earlier and stop the antibiotics at that point.
I take your comments to imply that the longer you take the antibiotics the more you increase your risk of permanent damage, even if it is with Zinnat?
As for the loud noices I am now very careful to bring ear plugs to loud events and I’m mostly to old for night clubs anyway… =)
Would it work similarily with antibiotics as with loud noices in the future that it will get worse every time I need to take an antibiotic cure?
Again many thanks!
Had tick byte 30.04.2019.Started IV Ceftriaxone on 17.06.2019 and on 16.07 My tinnitus started with one pill on empty stomache azhytromicin 0.250 gr. during 26th day IV ceftriaxone i feltstrong stomache pain and than took yoghurt and (magnesium to decrease effectiveness azythromycin)But evening start slowly right ear and 3days increase with IV ceftriaxone to high pitch coming from the bottom of brain spreas to ear nerves,1 year later is still 24/7 tinnitus.Now when took azyhtromicine once per week and try yoghurt again the sound increase severely and decresase to its basic.
I’ve been prescribed cefdinir for a uti, I might be able to take keflex. Otoxicity risk?
Hi Erica:
Cefdinir is less ototoxic than Cephalexin (Keflex) so it should be the better choice for a UTI as long as you don’t have a reaction to Cephalosporin antibiotics.
Cordially,
Neil
Hi Neil! I hope you are doing great and having a wonderful summer!!
My digestive issues from taking those horrible antibiotics last year have continued. I’ve improved some but right now I really need to take a laxative. I’ve tried every conceivable natural solution over many months. That includes many forms of magnesium. Do you know anything about Miralax?
Thanks very much!
Hi Tina:
Miralax is a brand name for the chemical polyethylene glycol. “Polyethylene glycol, otherwise known as PEG, is a mixture of bonded polymer plastic compounds that are combined with glycol to make a thick sticky liquid. PEG is manufactured for use in paints, wood treatments, detergents, cleaners and coatings. Somehow, the chemical has worked its way into cosmetics, canine wellness products and medicine. Sounds healthy, right?” That’s my sentiments too.
It is reported to cause hearing loss, tinnitus, ataxia, balance disorders, dizziness, vertigo and ear pain to name some of its ototoxic properties. I put it in the class 2 risk category (out of 5) as far as ototoxicity goes.
Feel free to take it if you want to, but just be aware of some of the risk factors associated with it. Maybe you want to try it while you get a handle of what is really going on (see below).
Have you seen an naturopathic doctor (ND)? That is what I’d do. Have you investigated to see if you have leaky gut syndrome, or if your gut bacteria are “good guys” instead of predominantly “bad guys”?
Cordially,
Neil
Yes I’ve spent thousands of hours researching at this point, and consulted a mix of naturopaths and conventional gastro docs. They have no good answers for certain gastro issues, unfortunately. The best answer is to try to resolve the conditions with laxatives. They want me to take magnesium oxide, which would be awesome. But that causes insomnia. I’ve tried multiple brands and types of magnesium. That really leaves only miralax. It’s a long story. I’m definitely well versed on the good v bad bacteria. It’s just not working. Harsh antibiotics last year just screwed me up. This was this was third line antibiotics they never, ever should have prescribed me, per multiple docs.
My only other option is endure the insomnia every few days and struggle without sleep. But taking it daily would be better for the constipation issue. I actually tried about 1/20 of the normal dose for miralax and within one hour had a HORRIBLE and really crazy mix of volume and sound in my Tinnitus. That lasted 3 days. Holy hell. I threw it away immediately. But I have just been wondering if maybe something else caused it. So U wanted to hear your thoughts. Thank you sir!
Another doc suggestion was mineral oil, but that seems just as scary. That spiked my Tinnitus, too, but not as long or as bad as the miralax.
Oh and I took an effective dose of the mineral oil (1 Tbsp). Versus the miralax was literally just at tiny layer in a cap that was supposed to be full. Maybe a half a teaspoon.. Totally ineffective at the dose I took AND still a gigantic Tinnitus spike. I was afraid for 3 days that it would never go back down.
Neil what do you recommend for anxiety? Everything that’s happened has given me pretty bad anxiety, and apparently (similar to tinnitus) that makes the digestive symptoms worse. I mean besides, of course, “focus on the loves of your life “
Hi Tina:
I wrote to you via email because my information is far too long to quote here.
Cordially,
Neil
Also what do you think about gabapentin? The doc thinks I have vagal nerve damage and also wants me to take what she says is a very low dose — 200 mg per day (divided — 100 mg morning & night), for 6-12 mos.
Hi Tina:
I’m definitely not a fan of taking Gabapentin. I’ve heard too many stories of people getting severe tinnitus just from taking 100 mg doses–and you are supposed to take double that and for up to a year.
The most common ototoxic side effects reported by thousands upon thousands of people include hearing loss, tinnitus, ataxia, balance disorder, dizziness and vertigo. And then there are all the other side effects it has on your body.
Knowing what I know about this drug, if it were me, I certainly wouldn’t take it.
Cordially,
Neil
Hi Neil,
Thanks for all the helpful information on this site. I’m 57 years old and have been having trouble with my ears for the past month. It’s a long story but started with a virus, a bout of vertigo, a suspected sinus infection and a course of augmentin. I’m now struggling with tinnitus, fullness in the ears and mild hearing loss. My ears now seem super sensitive to antibiotics. It’s been 2 weeks since I stopped augmentin and now have a tooth infection and need antibiotic again as I just had tooth extracted. Which is less ototoxic, penicillin or kelfex?
I’m on penicillin which seemed fine at first but on 4th day has spiked ear ringing and feels as though I’m losing more hearing. Kefelx is an option.
Thank you,
Connie
Hi Connie:
Both Penicillin and Cephalexin (Keflex) are about the same in degree of ototoxicity so in my opinion it really doesn’t matter which one you take. However, since you have had a bad reaction to Penicillin, I agree with you that Cephalexin is probably the better choice for you.
And to not make matters worse, if I were you, I’d stop taking the Cephalexin as soon as the infection has died and not take it for more than 1 day longer (for insurance). In other words, I do not take a course of antibiotics for the 7 or 10 or 14 days the doctor prescribes–just until the infection is dead and 1 more day. That reduces your risk of ototoxic side effects. I’ve done this with Cephalexin in the past and never had any ototoxic problems with my ears.
Cordially,
Neil