Azithromycin Eye Drops

[Donny D]

Hi,p

I would be grateful for some advice. I have had pulsatile tinnitus in my left ear since 4/9/2007 and ringing tinnitus in my right ear since 22/6/2013. I get spikes on and off and lately I was having a good period tinnitus wise. However, I have been having trouble with my eyes the last couple of months- posterior blepharitis. I finally got to see an ophthalmologist on Friday 5 June 2015 and was prescribed Azyter 15mg eye drops which contain azithromycin (one drop in each eye, twice a day for 3 days) then repeat this for 3 days for the next 2 months. I was also advised to take a steroid drop FML, twice a day for 3 weeks and then once a day for a week, then stop. Anyway I got myself really anxious about taking this steriod drop as my mum has glaucoma. Consultant wasn't interested in my concerns and didn't seem to like being questioned. I totally forgot to mention to him that I also suffered from tinnitus. Anyway, I got my prescription and yesterday morning started using them. A couple of hours after administering the first dose of Azyter 15mg I have noticed an increase in the ringing tinnitus in my right ear. I phoned a GP and was advised that was not ototoxic and that it would be extremely unlikely for an eye drop to have an effect on tinnitus. I also contacted 3 pharmacists, 2 told me it should not do this and one said there was a possibility that it might. My tinnitus does also increase with stress and I had got myself stressed about taking a steroid drop - still to start these. Anyway, I have now taken 3 doses of the eye drop with another 3 to go to finish the course. The increase in the tinnitus has not got any worse from I started my first dose yesterday but it has not got any better. I don't know what to do - should I finish the course or not take anymore and try and contact the doctor who prescribed them tomorrow - Sunday today
I would be grateful if you could advise if an eye drop containing such a small amount of azithromycin could worsen tinnitus - a one dose vial conatins 3.75mg of azithromycin. I would be grateful for your urgent advice.

 

[Dr. Nagler]

I would be grateful if you could advise if an eye drop containing such a small amount of azithromycin could worsen tinnitus - a one dose vial conatins 3.75mg of azithromycin. I would be grateful for your urgent advice.

So this is actually a very important question - not only for you in your decision process, but for the purpose of making a general point.

We like to think that medicine is all science-based. If nothing else, it gives us a certain reassurance in that regard. So from a scientific standpoint, there is absolutely no reason I can think of that such a small amount of azithromycin could possibly present any sort of problem for a tinnitus patient, especially if instilled in the eye. Therefore, speaking strictly as a medical doctor, I see no reason that you shouldn't complete your course of treatment exactly as prescribed.

All that aside ... from a highly biased totally non-scientific standpoint, I just wouldn't take the chance. Why? Because way back in the late 1990s I saw a number of patients in my clinic within a span of just a few weeks who had developed severe irreversible tinnitus while on normal doses of azithromycin by mouth, one of whom was the wife of a medical colleague of mine. And that impressed the hell out of me at the time. To be honest, I cannot off-hand recall seeing any since then - and there are no controlled studies in the literature suggesting that azithromycin can cause severe irreversible tinnitus - but since there are so many antibiotics that are equally effective for the same indications, I personally would not take the chance, not even with eye drops. It's just a gut feeling, an opinion likely worth nothing more than what you are paying for it.

Dr. Stephen Nagler

 

[Donny D]

Dear Dr Nagler, in response to my post yesterday you advised as a gut feeling that I should stop my azithromycin eye drops due to tinnitus. However I am a bit confused as in an earlier response to someone querying whether they should take clairithromycim or azrithromycin orally you advised that it turned out azrithromycin wasn't that much of a problem and you hadn't seen any cases in over 12 years. I really don't know what to do for the best my eye drop course is only one drop twice a day for 3 days in the next 3 months. I am half way through the course and really don't know what to do.

 

[Dr. Nagler]

I am half way through the course and really don't know what to do.

I am not aware of any medical reason that you should stop the medication. As I explained in my initial response, my "gut feeling" that you should stop it and ask for a different but equally efficacious antibiotic was based on anecdote and not on science.

But specifically as to what you should do, that one's easy. Contact your doctor, explain the situation, and follow his or her advice.

Dr. Stephen Nagler