<prompt> All of the following drugs can cause hearing loss except:VancomycinKanamycinMetronidazoleQuinine  <response>: Ans. c. Metronidazole Ref: Goodman Gillman I2e p1512,1542.1407, Katzung 12e p824Metronidazole does not cause hearing loss.All aminoglycosides are ototoxic and nephrotoxic. Ototoxicity and nephrotoxicity are more likely to be encountered when therapy is continued for more than 5 days, at higher doses, in the elderly, and in the setting of renal insufficiency. Concurrent use with loop diuretics eg, furosemide, ethacrynic acid or other nephrotoxic antimicrobial agents eg. vancomycin or amphotericin can potentiate nephrotoxicity and should be avoided if possible. Neomycin, kanamycin, and amikacin are the most ototoxic agents. Streptomycin and gentamicin are the most vestibulotoxic, bleomycin, tobramycin, and gentamicin are the most nephrotoxic. --Katzung 12e p824Vestibular and auditory dysfunction can follow the administration of any of the aminoglycosides, and ototoxicity may become a dose-limiting adverse effect. Aminoglycoside induced ototoxicity results in irreversible, bilateral high-frequency hearing loss and temporary vestibular hypofunction. --Goodman Gillman 12e p1512Auditory impairment, sometimes permanent, may follow the use of vancomycin or teicoplanin. Ototoxicity is associated with excessively high concentrations of these drugs in plasma 60-100 ugmL of vancomycin. -Goodman Gillman 12e p1542The fatal oral dose of quinine for adults is 2-8 g. Quinine is associated with a triad of dose-related toxicides when given at full therapeutic or excessive doses. These are cinchonism, hypoglycemia, and hypotension. Hearing and vision are particularly affected Functional impairment of the eighth nerve results in tinnitus, decreased auditory acuity, and vertigo. Visual signs consist of blurred vision, disturbed color perception, photophobia, diplopia, night blindness, constricted visual fields, scotomata, mydriasis, and even blindness. --Goodman Gillman 12e p1407Drugs causing OtotoxicityAntibiotics AminoglycosidesQ VancomycinQChemotherapeutic drugs CisplatinQDiuretics Ethacrynic acidQ FurosemideQOthers QuinineQ SalicylatesQ Aminoglycosides Side-Effects MaximumMinimumOtotoxicity AmikacinQ Auditory StreptomycinQ Vestibular NetilmycinQNephrotoxicity Neomycin GentamicinQ StreptomycinQNeuromuscular Blockade Neomycin StreptomycinQ TobramycinQ 