Which symptom should be assessed before the next dose of vancomycin?

• A. Hearing loss
• B. Headache
• C. Nausea
• D. Drowsiness

Answer: (A)

Vancomycin carries a notable risk of ototoxicity, meaning it can damage the inner ear and affect hearing. Checking for any new or worsening hearing changes before the next dose helps catch early signs of toxicity so the dose can be adjusted or the drug stopped to prevent irreversible hearing loss. Tinnitus or dizziness can accompany ototoxicity, but hearing assessment directly targets the toxicity risk that guides safe dosing. While other symptoms like headache, nausea, or drowsiness may occur with many drugs, they do not specifically signal imminent ototoxic risk or prompt dose modification as effectively as monitoring hearing does. Baseline and ongoing hearing checks are particularly important for patients with preexisting hearing loss or when high trough levels are anticipated.