A male client with tuberculosis returns to the clinic for daily antibiotic injections for a urinary infection. The client has been taking antitubercular medications for 10 weeks and states he has ringing in his ears. Which prescribed medication should the practical nurse (PN) report to the healthcare provider?

A. Rifampin 600 mg PO daily: Rifampin is a standard antitubercular medication known for causing orange discoloration of body fluids and potential hepatotoxicity, but it is not associated with ototoxicity. B. Gentamicin 160 mg IM daily: Gentamicin is an aminoglycoside antibiotic with a well-documented risk of ototoxicity and nephrotoxicity. The client’s report of tinnitus suggests early ototoxic damage, making it essential for the PN to report this finding immediately to prevent irreversible hearing loss. C. Pyridoxine with a B complex multivitamin: Pyridoxine (vitamin B6) is commonly prescribed with isoniazid to prevent peripheral neuropathy caused by interference with vitamin metabolism. It does not contribute to tinnitus. D. Isoniazid 300 mg PO daily: Isoniazid can cause peripheral neuropathy and hepatotoxicity but is not linked to ototoxic effects. The client’s auditory symptoms are unrelated to isoniazid therapy, making gentamicin the priority medication to report.