{"id":3186,"date":"2012-09-11T12:17:30","date_gmt":"2012-09-11T16:17:30","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=3186"},"modified":"2015-06-04T15:13:59","modified_gmt":"2015-06-04T19:13:59","slug":"are-fluoroquinolones-really-more-dangerous-than-other-antibiotics","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/are-fluoroquinolones-really-more-dangerous-than-other-antibiotics\/2012\/09\/11\/","title":{"rendered":"Are Fluoroquinolones Really More Dangerous Than Other Antibiotics?"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/09\/VitaminQ1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright  wp-image-3197\" title=\"VitaminQ\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/09\/VitaminQ1.jpg\" alt=\"\" width=\"262\" height=\"197\" \/><\/a>In today&#8217;s <em>New York Times<\/em>, health writer Jane Brody <a href=\"http:\/\/well.blogs.nytimes.com\/2012\/09\/10\/popular-antibiotics-may-carry-serious-side-effects\/?src=me&amp;ref=general\" target=\"_blank\">slams quinolone antibiotics:<\/a><\/p>\n<blockquote><p>Part of the problem is that fluoroquinolones are often inappropriately prescribed. Instead of being reserved for use against serious, perhaps life-threatening bacterial infections like\u00a0hospital-acquired pneumonia, these antibiotics are frequently prescribed for\u00a0sinusitis,\u00a0bronchitis, earaches and other ailments that may resolve on their own or can be treated with less potent drugs or nondrug remedies \u2014 or are caused by viruses, which are not susceptible to antibiotics.<\/p><\/blockquote>\n<p>True enough &#8212; although one could say the same thing about <em>every<\/em> antibiotic, which is something most ID doctors do on a regular basis. Sometimes this convinces patients who request antibiotics to go without, sometimes not.<\/p>\n<p>Brody then goes on to describe several of the more notable &#8212; plus some very rare &#8212; quinolone side effects, including:<\/p>\n<ul>\n<li>renal failure<\/li>\n<li>retinal detachment<\/li>\n<li>C diff<\/li>\n<li>tendonitis and tendon rupture<\/li>\n<li>neuromuscular blockade<\/li>\n<li>CNS side effects<\/li>\n<li>rashes and phototoxicity<\/li>\n<\/ul>\n<p>But the centerpiece of the article is a case history of someone who developed severe, multisystem, and debilitating side effects after the first, and especially the second, dose of levofloxacin:<\/p>\n<blockquote><p>After just one dose, he developed widespread pain and weakness &#8230;\u00a0But the next pill, he said, \u201ceviscerated\u201d him, causing pain in all his joints and\u00a0vision problems.\u00a0In addition to being unable to walk uphill, climb stairs or see clearly, his symptoms included\u00a0dry eyes, mouth and skin; ringing in his ears;\u00a0delayed urination; uncontrollable shaking; burning pain in his eyes and feet; occasional tingling in his hands and feet;\u00a0heart palpitations; and muscle spasms in his back and around his eyes.<\/p><\/blockquote>\n<p>It&#8217;s great that the downside of inappropriate antibiotic usage is getting more attention (normal bacterial flora are your friends), and of course fluoroquinolones are by no means 100% safe, as I noted <a href=\"http:\/\/blogs.nejm.org\/index.php\/id-learning-unit-choosing-a-quinolone\/2012\/06\/24\/\" target=\"_blank\">here<\/a>.<\/p>\n<p>But I wonder &#8212; are they truly more dangerous than other antibiotics? Or is this a matter of heavy usage of relatively new drugs, hence more notoriety?<\/p>\n<p>What do you think?<\/p>\n<div id=\"polls-5\" class=\"wp-polls\">\n\t<form id=\"polls_form_5\" class=\"wp-polls-form\" action=\"\/index.php\" method=\"post\">\n\t\t<p style=\"display: none;\"><input type=\"hidden\" id=\"poll_5_nonce\" name=\"wp-polls-nonce\" value=\"77783cfeb8\" \/><\/p>\n\t\t<p style=\"display: none;\"><input type=\"hidden\" name=\"poll_id\" value=\"5\" \/><\/p>\n\t\t<p style=\"text-align: center;\"><strong>True or False: Fluoroquinolones are more dangerous than other antibiotics.<\/strong><\/p><div id=\"polls-5-ans\" class=\"wp-polls-ans\"><ul class=\"wp-polls-ul\">\n\t\t<li><input type=\"radio\" id=\"poll-answer-15\" name=\"poll_5\" value=\"15\" \/> <label for=\"poll-answer-15\">True -- they should only be used when safer alternatives are contraindicated.<\/label><\/li>\n\t\t<li><input type=\"radio\" id=\"poll-answer-16\" name=\"poll_5\" value=\"16\" \/> <label for=\"poll-answer-16\">False -- all antibiotics have risks, FQ are getting attention because they are so widely used.<\/label><\/li>\n\t\t<\/ul><p style=\"text-align: center;\"><input type=\"button\" name=\"vote\" value=\"   Vote   \" class=\"Buttons\" onclick=\"poll_vote(5);\" \/><\/p><p style=\"text-align: center;\"><a href=\"#ViewPollResults\" onclick=\"poll_result(5); return false;\" title=\"View Results Of This Poll\">View Results<\/a><\/p><\/div>\n\t<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>In today&#8217;s New York Times, health writer Jane Brody slams quinolone antibiotics: Part of the problem is that fluoroquinolones are often inappropriately prescribed. Instead of being reserved for use against serious, perhaps life-threatening bacterial infections like\u00a0hospital-acquired pneumonia, these antibiotics are frequently prescribed for\u00a0sinusitis,\u00a0bronchitis, earaches and other ailments that may resolve on their own or can [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8],"tags":[72,187,367,562,629],"class_list":["post-3186","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","tag-antibiotics","tag-ciprofloxacin","tag-fluoroquinolones","tag-levofloxacin","tag-moxifloxacin"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/3186","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=3186"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/3186\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=3186"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=3186"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=3186"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}