UPDATE FOR THE USE OF FLUORQUINOLONE ANTIBIOTICS
Antibiotics are still overly prescriptive, e.g. if a mild infection could cure without medication, or if it is not at all sure if it is really a bacterial and not a viral infection against which antibiotics are ineffective. This leads to the well-known problem of resistance development which makes antibiotics ineffective when we actually need them. In the group of fluoroquinolones extra caution is now required in the application, because of the possible serious unwanted side effects, which in some cases could persist beyond the application for months or even permanently.
Fluorquinolones is a group of antibiotics that is often prescribed – especially in the presence of penicillin allergy -for respiratory infections, urinary tract infections, otitis media, and – very controversial – as prophylaxis for the traveler’s diarrhea. Fluorquinolones include the following in Europe approved agents: Ciprofloxacin, Norfloxacin, Enoxacin, Ofloxacin, Levofloxacin, Moxifloxacin, Cinoxacin, Lomefloxacin, Pefloxacin, Prulifloxacin, Rufloxacin, Pipemidic Acid, Nalixidic Acid and Flumechin. The reported adverse drug reactions of fluorquinolone antibiotics have led to research and new restrictions by the EMA (European Medicines Agency). Cinoxacin, Flumechin, Nalidic Acid and Pipemidic Acid have been withdrawn from the market. Restrictions have been imposed on all remaining active substances in the fluorquinolone group.
Among the dreaded adverse effects that the patient should be aware about of are: tendon inflammation and tears, muscle pain and weakness, joint pain and swelling, difficulty in walking, feelings of pinpricks and tingling, burning pain, fatigue, depression, memory disorders, sleep disorders, vison disorders, hearing disorders, changes in taste and smell, increased risk of aortic aneurysm and aortic dissection.
One or more organs can be affected simultaneously. The tendon swelling and injuries can occur within two days or a months later after stopping the medication. It is especially affected the Achilles tendon
Patients who are taking a fluorquinolone antibiotic and experience any of the symptoms described above should stop the medication and contact their doctor immediately!
Therefore, fluorquinolones should only be prescribed after the most careful risk-benefit analysis. They should only be used if, as an alternative, no other antibiotic is available.
Their use should be reserved for severe, life-threatening bacterial infections where other antibiotics are ineffective. Fluorquinolones should not be used for mild to moderate infections when, alternatively, other antibiotics are available, for prevention of traveler’s diarrhea and for non-bacterial infections, e.g. chronic prostatitis. The risk group to develop the above mentioned adverse drug reactions include: elderly people, patient taking concomitant cortisone, patients with renal impairment, patients who have already responded to quinolones and fluorquinolones.
It is important to note, however, that fluorquinolones have a very broad spectrum of activity against both gram-negative and gram-positive bacteria and, in some cases from heavy infections where other antibiotic fail, can be life-saving. It is important, that fluoquinolones are administered only under strict medical supervision and after detailed information of the patient about possible adverse effects.
Fluorchinolone: Indikationen sollen deutlich eingeschränkt werden
Systemisch und inhalativ angewendete Fluorchinolone: Risiko für Aortenaneurysmen und -dissektionen
EMA European Medicines Agency – Effetti indesiderati invalidanti e potenzialmente permanenti hanno comportato la sospensione o restrizioni nell’ uso di antibiotici chinolonici e fluorochinolonici