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Serious Side Effects of Popular Antibiotics
#1
This report by the New York Times highlights some of the risks involved.

Antibiotics are important drugs, often restoring health and even saving lives. But like all drugs, they can have unwanted and serious side effects, some of which may not become apparent until many thousands of patients have been treated.

Such is the case with an important class of antibiotics known as fluoroquinolones. The best known are Cipro (ciprofloxacin), Levaquin (levofloxacin) and Avelox (moxifloxacin). In 2010, Levaquin was the best-selling antibiotic in the United States.

But by last year, it was also the subject of more than 2,000 lawsuits from patients who had suffered severe reactions after taking it.

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 hospital-acquired pneumonia, these antibiotics are frequently prescribed for sinusitis, bronchitis, earaches and other ailments that may resolve on their own or can be treated with less potent drugs or non drug remedies — or are caused by viruses, which are not susceptible to antibiotics.

Source: http://tribune.com.ng/index.php/your-hea...de-effects
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#2
Adverse effects of fluoroquinolones

Fluoroquinolones are large and important group of synthetic antibiotics of broad spectrum of activity. These antibiotics are mainly prescribed for treatment of hospital acquired bacterial infections that can’t be treated with other antibiotics. However, their use in the past couple of years increased, resulting in increased number of infections caused by multidrug resistant strains such as Clostridium difficile and MRSA (Methicillin resistant Staphylococcus aureus). They achieve therapeutic effect through interaction with DNA gyrase, which result in inhibition of bacterial DNA replication. 9,2 of each 10 000 cases prescribed with fluoroquinolones end up in the emergency room due to severe adverse effects. Side effects could be seen after a single dose, or few months after therapy is discontinued. Mechanism of toxicity is associated with inhibition of selective GABA receptors in the central nervous system that induces excitotoxicity and oxidative stress.

Here are some rare but serious side effects associated with fluoroquinolones:

Gastrointestinal system

Fluoroquinolones are associated with hepatotoxicity, hepatic failure and cholestatic hepatitis. 2-20% of patients on fluoroquinolones therapy experience diarrhea, vomiting, abdominal pain and taste disturbance. Antibiotic of broad spectrum of activity easily destroys gut microflora and creates perfect environment for the growth of Clostridium difficile. This pathogen may induce pseudomembranous colitis and severe diarrhea that could be fatal if not treated on time.

Musculoskeletal system

Fluoroquinolones impair cartilage and ligaments. Joint pain and swelling has been observed in 1% of people receiving fluoroquinoles. This side effect is transient and patients usually feel better few days after they complete the therapy. More severe side effect, recorded in 0.1-0.4% (3 cases out of 1000) cases, is a tendon rupture. Achilles tendon is not the only one that could rupture, but it will rupture more commonly compared to other tendons. Tendotoxicity could be identified early (after few doses), or later (after 12 weeks), when treatment is already completed. Tendon rupture may affect more than one tendon in the body and effects may persist longer period of time (6 months after finished therapy). Fibromyalgia is also known side effect of therapy with fluoroquinolones. From November 1997 to November 2001, Levofloxacin induced 2898 cases of tendon, muscle, bone and ligament damage, while Ciprofloxacin (during the same period of time) induced 1558 adverse effects of the same kind.

Central nervous system

Fluoroquinolones are associated with various psychiatric side effects that could persist for one month or longer (a year after therapy). Although rarely, antibiotics of this class have been associated with suicide attempts, but more often they induce ahedonia, depression, cognitive dysfunction, anxiety, paranoia, hallucinations, seizures, insomnia, vertigo, abnormal dreams…Long list of CNS associated effects is result of GABA inhibition, that leads to decreased uptake of glucose, neuronal degeneration and/or inflammation and electrolyte imbalance.

Integumentary system

Photosensitivity reaction and serious cutaneous reactions such as: painful rash, Stevens-Johnsons syndrome, toxic epidermal necrolysis are well known side effects of fluoroquinolones. Besides Levofloxacin and Ciprofloxacin, these adverse effects were recorded with Norfloxacin, Ofloxacin, and Trovan. Photosensitivity reaction can be mild (like sun burns or edema), while advanced stages are associated with painful blisters and peeling of the skin.

Peripheral nervous system

Peripheral neuropathies are rarely seen with fluoroquinolones and they usually include tingling, numbness, pain and weakness. Some peripheral neuropathies like fasciculations (muscle twitching), paresthesia (tingling), tinnitus (perception of sound in the ear without external sound sensations) and hyperacusis (increased sensitivity toward certain frequencies of sounds) are irreversible.

Visual system

Fluroquinolones are cytotoxic to the corneal keratinocytes and epidermal cells. Visual disturbances such as blurred vision, diplopia (double vision), floaters (various deposits in the vitreous humor of the eye), color distortion and altered vision are recorded with different fluoroquinolones. Diplopia is usually observed with Norfloxacin, Ciprofloxacin and Levofloxacin. These effects may be transient, but some may persist for few years after therapy. Irreversible cases of blindness were reported for some fluoroquinolones, while serious macular detachment has been reported with flumequine.

Fluoroquinolones may negatively affect many other tissues and organs. Despite being associated with severe and serious side effects, fluoroquinolones are irreplaceable in modern clinical practice. Both doctors and patients need to be careful with fluroquinolones. They should be used when other classes of antibiotics don’t produce desirable therapeutic effect. They are contraindicated in patients that suffer from diabetes, myasthenia gravis, psychiatric or renal disorders. They should not be prescribed to pregnant women and children under the age of 18.
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