What Antibiotic Can Cause Dizziness? Identifying the Culprits

October 13, 2025 •

5 min read

While generally rare, antibiotic-induced neuropsychiatric toxicity can range from mild confusion to severe symptoms, with dizziness being a notable side effect. This article explores what antibiotic can cause dizziness, examining the various classes of drugs responsible and the potential mechanisms behind this vestibular disturbance.

Quick Summary

Many antibiotics, including aminoglycosides, fluoroquinolones, and metronidazole, can cause dizziness or vertigo. These effects can stem from inner ear damage (ototoxicity) or central nervous system impacts. Risk factors include dosage, kidney function, and underlying conditions, making it crucial to consult a healthcare provider if symptoms arise.

Key Points

Aminoglycosides: Potent antibiotics like gentamicin and streptomycin can cause ototoxicity, damaging the inner ear and causing permanent dizziness and balance issues.
Fluoroquinolones: Drugs such as ciprofloxacin and levofloxacin can cause dizziness by affecting the central nervous system, particularly the GABA receptor system.
Metronidazole: Prolonged use can lead to neurotoxicity and encephalopathy, with symptoms including dizziness, vertigo, and ataxia that are usually reversible.
Risk Factors: High doses, prolonged therapy, poor kidney function, and underlying neurological conditions can increase the risk of antibiotic-induced dizziness.
Mechanisms: Dizziness can result from inner ear damage, CNS disruption, allergic reactions, or general systemic effects like dehydration.
Patient Action: If you experience dizziness, contact your doctor immediately, avoid driving or operating machinery, and stay hydrated; do not stop medication without medical advice.

What Antibiotic Can Cause Dizziness?

For individuals undergoing treatment for a bacterial infection, encountering unexpected side effects can be alarming. Dizziness is one such side effect that can disrupt daily life and cause concern. While not all antibiotics pose this risk, several classes are known to affect the nervous or vestibular systems, leading to feelings of lightheadedness, unsteadiness, or true vertigo. Understanding these potential culprits and the mechanisms behind their effects is a crucial aspect of patient safety and care. It is important to note that the occurrence and severity of these side effects can depend on individual factors, such as kidney function, age, and dosage.

Antibiotic Classes That May Cause Dizziness

Aminoglycosides This class of potent antibiotics is used to treat serious bacterial infections. Aminoglycosides, including gentamicin, streptomycin, and tobramycin, are a well-documented cause of ototoxicity, which involves damage to the structures of the inner ear. Since the inner ear is responsible for both hearing and balance, this damage can lead to permanent hearing loss and/or balance problems, including dizziness and vertigo. The risk of these effects is often tied to the dose, duration of therapy, and the presence of pre-existing kidney issues.

Fluoroquinolones Fluoroquinolones like ciprofloxacin, levofloxacin, and ofloxacin can affect the central nervous system (CNS) and have been associated with a range of neurotoxic side effects, including dizziness, headache, and insomnia. These effects are thought to be caused by the inhibition of gamma-aminobutyric acid (GABA) receptors, a key neurotransmitter system in the brain. Older patients or those with pre-existing CNS disorders may be at higher risk.

Metronidazole This common antibiotic can cause neurotoxicity, particularly with prolonged use, which may lead to a condition called metronidazole-induced encephalopathy. Symptoms can include dizziness, vertigo, unsteadiness, and confusion. While these effects are rare and typically reversible upon discontinuation of the drug, they underscore the importance of monitoring for any new neurological symptoms during treatment.

Macrolides Macrolide antibiotics such as clarithromycin and erythromycin have been linked to neuropsychiatric side effects, including dizziness and confusion. The mechanism is complex and may involve interactions with CNS neurotransmitters or other metabolic pathways. While not as common as with aminoglycosides, these effects should be considered, especially in vulnerable populations.

Other Antibiotics

Penicillins (e.g., Amoxicillin): While typically well-tolerated, some patients report experiencing dizziness with amoxicillin, though the mechanism is not always clear and may be linked to general malaise or allergic reactions. Rare cases of neurotoxicity and encephalopathy have been reported with high doses, particularly in those with renal impairment.
Cephalosporins (e.g., Cephalexin): Dizziness is an infrequent side effect of this antibiotic class. It can also be a symptom of a severe allergic reaction (anaphylaxis). As with penicillins, renal impairment can increase the risk of neurotoxic effects.

Mechanisms Behind Antibiotic-Induced Dizziness

There are several distinct ways in which antibiotics can disrupt the body's balance, leading to a sensation of dizziness:

Ototoxicity: Aminoglycosides are the primary examples of antibiotics that cause damage to the inner ear (ototoxicity). This directly affects the vestibular system, which controls balance, leading to vertigo, unsteadiness, and, in severe cases, permanent balance issues.
Central Nervous System (CNS) Effects: Certain antibiotics, notably fluoroquinolones and metronidazole, cross the blood-brain barrier and can interfere with brain chemistry. This disruption can inhibit neurotransmitters like GABA, leading to symptoms such as dizziness, confusion, and anxiety.
Hypersensitivity and Allergic Reactions: Dizziness can be one of many symptoms of an allergic reaction to an antibiotic. In severe cases like anaphylaxis, it can accompany fainting, low blood pressure, and trouble breathing.
Systemic Side Effects: Non-specific effects like dehydration from vomiting or diarrhea, or feeling generally unwell (malaise), can also cause or exacerbate feelings of lightheadedness.
Renal Insufficiency: For many antibiotics, the kidneys are responsible for clearing the drug from the body. In patients with poor kidney function, the drug can build up to toxic levels, increasing the risk of neurotoxicity and dizziness.

Comparison of Dizziness-Causing Antibiotics


Antibiotic Class	Examples	Primary Mechanism	Risk Factors	Potential Severity
Aminoglycosides	Gentamicin, Tobramycin, Amikacin	Ototoxicity (inner ear damage)	High dose, extended therapy, renal insufficiency, older age	Moderate to Severe (can be permanent)
Fluoroquinolones	Ciprofloxacin, Levofloxacin	CNS disruption (GABA inhibition)	Older age, renal insufficiency, concurrent CNS drugs	Mild to Moderate
Metronidazole	Metronidazole	CNS disruption, Neurotoxicity	Prolonged therapy, high doses	Moderate to Severe (reversible with stopping)
Macrolides	Clarithromycin, Erythromycin	CNS effects (complex)	Pre-existing psychiatric conditions	Mild to Moderate
Penicillins	Amoxicillin	General malaise, CNS effects (rare)	High doses, renal insufficiency, allergy	Mild to Moderate (often mild)
Cephalosporins	Cephalexin, Cefepime	CNS effects (rare), General malaise	High doses, renal insufficiency, allergy	Mild to Moderate (often mild)

What to Do If You Experience Dizziness

If you experience dizziness or other concerning symptoms while taking an antibiotic, follow these steps:

Contact Your Healthcare Provider: This is the most crucial step. Your doctor can determine if the dizziness is related to the antibiotic, requires a change in medication, or signals a more serious issue.
Move Slowly: Sudden changes in position can worsen dizziness. Sit or stand up slowly to give your body time to adjust, which can help prevent falls.
Stay Hydrated: Dehydration can contribute to lightheadedness. Ensure you are drinking plenty of fluids, especially if you are also experiencing vomiting or diarrhea.
Avoid Driving or Operating Machinery: Dizziness can impair coordination and reaction time. Do not engage in activities that require full mental alertness until your symptoms have resolved.
Do Not Stop Taking the Medication: Unless instructed by your doctor, do not abruptly stop your antibiotic course. This could lead to a relapse of the infection or contribute to antibiotic resistance.

Conclusion

While the vast majority of antibiotic courses are completed without significant side effects, it is helpful to know what antibiotic can cause dizziness so that you can recognize the symptoms and seek appropriate medical advice. Classes like aminoglycosides, fluoroquinolones, and metronidazole are more frequently implicated due to their effects on the vestibular system or central nervous system. Being aware of these possibilities allows for proactive communication with your healthcare provider. Your doctor can assess whether a change in medication is necessary, especially if you have underlying risk factors like poor kidney function or other CNS conditions, ensuring both the effective treatment of your infection and your overall safety. For more detailed information on specific drug side effects, authoritative resources like Medscape and the Mayo Clinic provide comprehensive drug monographs.

Medscape - Ototoxicity: Overview, Aminoglycosides, Other Antibiotics

Frequently Asked Questions

Yes, common antibiotics like amoxicillin can cause dizziness, although it is a less frequent side effect than gastrointestinal issues. It may be due to general malaise, dehydration, or, in rare cases with high doses or kidney issues, CNS effects.

Some antibiotics cause dizziness through different mechanisms: damaging the inner ear (ototoxicity, e.g., aminoglycosides), disrupting the central nervous system (CNS, e.g., fluoroquinolones and metronidazole), or as part of a systemic reaction or allergy.

In many cases, yes. Dizziness caused by CNS disruption from drugs like metronidazole often resolves after the medication is discontinued. However, inner ear damage from aminoglycosides can sometimes lead to permanent balance problems.

You should contact your healthcare provider immediately. They can evaluate your symptoms, adjust your dosage, or switch your medication if necessary. Do not stop taking the antibiotic on your own.

Yes, older adults are at a higher risk because they often metabolize drugs differently, may have pre-existing health conditions like impaired kidney function, and may be on other medications that can interact with antibiotics.

You should not take other medications to treat dizziness without consulting your doctor first. Some drugs can interact negatively with your antibiotic. Staying hydrated and moving slowly may provide some relief.

Dizziness can be a symptom of a mild allergic reaction, but in severe cases like anaphylaxis, it can be accompanied by more serious symptoms like breathing difficulties, hives, and a rapid pulse. Seek emergency medical care for any signs of a severe reaction.