Results of a systematic review including 44 publications found that, even at standard oral doses, macrolide exposure may lead to sensorineural hearing loss (SNHL).

The study authors performed both computerized and manual searches to identify studies involving patients who received macrolide antibiotics that had a documented outcome of SNHL. Data obtained from these studies included details of the drug regimen administered as well as the timing, severity, and reversibility of SNHL.

A total of 78 cases of SNHL were described in the 44 publications (3 prospective, 41 retrospective) identified from the search. Analysis of the cases found that standard doses of both oral and intravenous macrolide administration were associated with SNHL. The study authors noted that, “SNHL was irreversible in six cases, despite macrolide cessation (n=5) and oral steroid treatment (n=1)” and that “irreversible SNHL was observed following 2 to 3 days of exposure.” 

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Analysis also found that, in 70 cases, SNHL was reversible upon cessation of macrolide therapy alone. In 2 cases, hearing was restored after discontinuation of macrolide therapy as well as administration of oral steroids. The study authors noted that hearing typically improved within hours to days in patients with reversible SNHL. Subjective patient-reported hearing loss was described in 42 cases obtained from 9 studies. The authors stated that limitations of their study included study design, patient comorbidities, and concomitant drug use.

Results of this systematic review found that administration of standard doses of macrolides may be associated with SNHL. The study authors noted, however, that “further research is needed to understand the incidence, prevalence, and biological mechanism of its ototoxicity.”

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