Can 1 gm of Vancomycin in a 12 hour period cause tinnitus in man over 50?

Hello Wparsons,

Disclaimer: The information contained in this answer is intended to
educate the reader about certain medical conditions and treatments. It
is not a substitute for examination, diagnosis, and medical care
provided by a licensed and qualified health professional.


According to my research tinnitus has been associated with the use of Vancomycin.


Below you will find excerpts taken from articles and abstracts that
link the use of Vancomycin with tinnitus.

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?Ototoxic medications are those drugs that have the potential to cause
damage to the inner ear structures which may result in temporary or
permanent loss of hearing or an aggravation of an existing
sensorineural hearing loss

Some ototoxic medications when discontinued, result in complete
recovery of hearing and cessation of associated symptoms such as
tinnitus.?

Signs of Ototocity - Listed in Order of Frequency

- The development of tinnitus (noises in the ears) in one or both ears. 

- The intensification of existing tinnitus or the appearance of
another sound that didn't exist before.

- Fullness or pressure in your ears -- other than being secondary to
an upper respiratory infection.

- The awareness of a hearing loss in an unaffected ear or the
progression or fluctuation or an existing loss.

- The development of vertigo or spinning sensation usually aggravated
by motion and may or may not be accompanied by nausea.

Vancomycin is included in the list of ototoxic medications 

Vancomycin - Vancocin

?This antibiotic is used in a similar manner as the aminoglycosides;
when given intravenously in serious life-threatening infections, it is
potentially ototoxic. It is usually used in conjunction with the
aminoglycosides which enhances the possibility of ototoxicity.?

Source:
What You Should Know About Ototoxic Medications
by Stephen Epstein, M.D. - SHHH Journal

?Stephen Epstein, M.D., F.A.C.S., is an otologist and a fellow of the
American Academy of Otolaryngology - Head and Neck Surgery, Inc., and
the American College of Surgeons. He is the director of The Ear Center
in Wheaton, Maryland.?
http://www.pa-shhh.org/resources/epstein.html


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The article OTOTOXIC DRUGS by Orin Kaufman, D.O. indicates which most
commonly used medications could potentially cause damage to your
hearing, or aggravate an already existent problem.

Vancomycin is known to cause tinnitus.
  
ANTIBIOTICS  
 (Usually ototoxic when given in intravenous doses of 2-4 grams per 24
hours, especially if there is underlying kidney failure),  vancomycin
(Vancocin) 1,2.
1 = known to cause hearing loss  
2 = known to cause tinnitus  (ringing in the ear)
http://www.doctor.az/index.php?act=ototoxic

Ototoxic Medications:
Drugs That Can Cause Hearing Loss and Tinnitus 
Orin S. Kaufman, D.O.
Reprinted from the HEARING REHABILITATION QUARTERLY, VOLUME 22, NUMBER 2, 1997 
LEAGUE FOR THE HARD OF HEARING 
http://www.lhh.org/otology/ototoxic.htm


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According to an article from the American Family Physician, a
peer-reviewed journal of the American Academy of Family Physicians
Vancomycin (Vancocin) can cause tinnitus.

See Table 2: 

Medications and Substances that Can Cause Tinnitus 

- Analgesics 
- Aspirin 
- Nonsteroidal anti-inflammatory drugs 
- Antibiotics 
- Aminoglycosides 
- Chloramphenicol (Chloromycetin) 
- Erythromycin 
- Tetracycline 
- Vancomycin (Vancocin) 
 
Source:
American Academy of Family Physicians
January 1, 2004
http://www.aafp.org/afp/20040101/120.html


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There are some studies where tinnitus has been associated with the use
of Vancomycin.


Efficacy and safety of vancomycin constant-rate infusion in the
treatment of chronic Gram-positive bone and joint infections.

Bernard E, Perbost I, Carles M, Michiels A, Carsenti-Etesse H,
Chichmanian RM, Dunais B, Dellamonica P.
Department of Infectious and Tropical Diseases, Archet Hospital, 

OBJECTIVE: 
To evaluate the efficacy and safety of vancomycin constant-rate
infusion over 24 h in the treatment of Gram-positive bone infections,

Adverse events included pruritus (four cases), tinnitus (two), mild
transient elevation of creatinine level (three) and transient
neutropenia (two).

PubMed: National Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11864154


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Vancomycin toxicity: a prospective study.

Mellor JA, Kingdom J, Cafferkey M, Keane CT.

?A prospective study of 34 patients treated with 39 courses of
intravenous vancomycin, was undertaken in order to assess toxicity.
Six patients received vancomycin alone and 27 courses were associated
with aminoglycoside administration either concurrently or within two
weeks of the first dose of vancomycin. Hearing loss was slight and
uncommon; patients were unaware of its occurrence. Tinnitus and
dizziness was noted by two patients and resolved on withdrawal of
vancomycin.?

PubMed: National Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4030539


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?Cranial nerve toxicities, such as myopia, optic neuritis, deafness,
vertigo, and tinnitus, have been associated with the use of
erythromycin, sulfonamides, tetracyclines, chloramphenicol, colistin,
aminoglycosides, vancomycin, isoniazid, and ethambutol.?

PubMed: National Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6329054


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?Fifteen of 19 episodes of serious methicillin-resistant S. aureus
infection responded to vancomycin. Severe toxic effects included
tinnitus, neutropenia, rash, and possible nephrotoxicity.?

PubMed: National Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7114631


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Ototoxicity

?A few dozen cases of hearing loss associated with vancomycin have
been reported. Most of these patients had kidney dysfunction or a
preexisting hearing loss or were receiving concomitant treatment with
an ototoxic drug. Vertigo, dizziness, and tinnitus have been reported
rarely.?
http://www.rxlist.com/cgi/generic2/vancociniv_ad.htm


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Search criteria.
Vancomycin
Tinnitus


I hope this is helpful!


Best regards,
Bobbie7

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Request for Answer Clarification by wparsons-ga on 06 Mar 2005 23:27 PST

I knew that Vancomycin causes tinnitus. That is common knowledge. I
asked if there is any support for 1 gram of Vanomycin in 12 hours
causing tinnitus? Yes? No?

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Clarification of Answer by bobbie7-ga on 07 Mar 2005 05:47 PST

Dear Wparsons,

I did additional research and unfortunately I didn't find evidence
that 1 gram of Vanomycin in 12 hours causes tinnitus.

If this is not the answer you're looking for, please let me know and I
will ask the editors to remove my answer and that way another
researcher can try to find a more satisfactory answer to your
question.

Sincerely,
Bobbie7

Mr friend recently had routine knee surgery. He was not sick, but was
given vancomycin 1 gram IV. When he woke up he had tinnitus and
hearing loss.  It's been 7 months without change.  I would  also like
to know more about vancomycin being use on healty patients.  Will the
tinnitus go away, or is this a side effect? Will his hearing improve?

The typical plasma concentration of vancomycin required to produce the
toxicities such as tinnitus is generally agreed upon to be 80mg/L. 
From a pharmacokinetic standpoint it would be nearly impossible for
such a level to be reached with a 1gram dose in a 12 hour period.
Ototoicity is more commonly found in aminoglycoside antibiotics
(gentamycin, amikacin, etc).  It's incidence with vancomycin is very
rare at less than 1%.

The dose prescribed is a very common dose for most patients.  If this
patient were to have severe renal disease and required dialysis then
it would be possible to see increased concentrations.  However it is
still unlikely that the concentrations would be even close to 80. 
Also since this dose was prescribed to be given every 12 hours it
leads me to believe that this person was healthy and had normal renal
function.  If he were to have had some renal disease then the dose
would have been started as a once daily dose.


I'm not sure re: the reversability of the ototoxicity but I definitely
do not think that 1 gram of vancomycin every 12 hours would produce a
level of toxicity high enough to cause tinnitus.  If this were more
than a one time dose then the physician/pharmacist would definitely be
monitoring the serum concentration levels.

in regards to the question from bell4: Vancomycin is commonly used
prophylactically before knee surgery. The surgeons in your friends
case were only following current practice guidelines when they
administered vancomycin to a "healthy" patient who was about to have
knee surgery.