Which drug is nephrotoxic and ototoxic?

• A. Acetaminophen
• B. Chloramphenicol
• C. Vancomycin
• D. Ibuprofen

Answer: (B)

Nephrotoxicity and ototoxicity describe drug-induced damage to the kidneys and to the inner ear, respectively. Ototoxic injury often presents as hearing loss and tinnitus, while nephrotoxicity shows up as rising creatinine, reduced GFR, or other signs of impaired renal function.

Among these drugs, the one with a well-established risk to the kidneys is the antibiotic vancomycin. Its nephrotoxicity is dose- and duration-dependent, which is why monitoring trough levels is common practice to minimize risk. Ototoxicity with vancomycin is rare but can occur, especially at high troughs or in patients with preexisting kidney dysfunction or concurrent ototoxic agents.

Acetaminophen is mainly hepatotoxic at high doses and does not have a strong association with ototoxicity; any kidney effects are not a defining feature of its toxicity. Chloramphenicol is known for bone marrow suppression and other hematologic toxicities rather than kidney or ear toxicity. Ibuprofen can cause kidney issues in susceptible individuals due to impaired renal blood flow but is not classically associated with ototoxicity.

So vancomycin is the best match for a drug with nephrotoxicity and potential ototoxicity among these options.