Adverse Effects of Fluoroquinolones

Adverse Effects Of Fluoroquinolones

The fluoroquinolones are synthetic broad-spectrum antibiotics. In general, the common side-effects are mild to moderate and self-limiting. However, occasional serious adverse effects can occur. A study performed by the United States Centers for Disease Control (CDC) estimated that adverse events leading to an emergency room visit occur at a rate of 9.2 for every 10,000 fluoroquinolone prescriptions. This rate is greater than that for cephalosporins (6.1 per 10,000) and macrolides (5.1 per 10,000), but less than for sulfonamides (18.9 per 10,000), penicillins (13 per 10,000), clindamycin (18.5 per 10,000), and vancomycin (24.1 per 10,000).

Rare serious adverse drug reactions (ADRs) associated with fluoroquinolones include central nervous system (CNS) toxicity, phototoxicity, cardiotoxicity, arthropathy, and tendon toxicity. Children and the elderly are at greater risk. Tendonopathy may manifest during, as well as sometimes long after fluoroquinolone therapy has been discontinued. Events that may occur in acute overdose are rare and include renal failure and seizure.

Broad spectrum antibiotics including fourth generation cephalosporins, clindamycin, and fluoroquinolones may facilitate colonisation with MRSA and C. difficile. Several professional healthcare organizations have recommended limiting the use of broad spectrum antibiotics. The Society for Healthcare Epidemiology of America recommends minimizing the use of fluroquinolones in institutions where MRSA is endemic. The European Center for Disease Prevention and Control recommends avoiding the use of broad spectrum antibiotics including cephalosporins, clindamycin and fluoroquinolones. In an Italian study, prior treatment with cephalosporins or fluoroquinolones was associated with a higher risk of MRSA infection than prior treatment with non-cephalosporin beta lactam antibiotics. In 2008, the most widely used fluoroquinolones in the United States included ciprofloxacin, levofloxacin and moxifloxacin. Many others have been removed from the market, at least in some countries, due to serious ADRs and safety concerns, including gatifloxacin in 2006, grepafloxacin in 2003, temafloxacin in 1992, trovafloxacin and alatrofloxacin. Other quinolones have had their licensed indications restricted in certain countries due to toxicity issues. These include sparfloxacin in 1995, norfloxacin in 2008 and moxifloxacin in 2008.

Only limited research has been conducted into the long-term effects of fluoroquinolones, making epidemiology statistics of the incidence of fluoroquinolone induced tendonopathy difficult to ascertain. The(FDA) has investigated received case reports for tendon rupture. Based on their analysis of case reports, they have concluded that fluoroquinolones may cause long-term damage in rare cases. A Swedish study found that fluoroquinolones occasionally cause peripheral neuropathy, which in a sizable proportion of cases was long-lasting. The total number of reported cases, however, was only 37.