September 11th, 2012

Are Fluoroquinolones Really More Dangerous Than Other Antibiotics?

In today’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 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 nondrug remedies — or are caused by viruses, which are not susceptible to antibiotics.

True enough — although one could say the same thing about every antibiotic, which is something most ID doctors do on a regular basis. Sometimes this convinces patients who request antibiotics to go without, sometimes not.

Brody then goes on to describe several of the more notable — plus some very rare — quinolone side effects, including:

  • renal failure
  • retinal detachment
  • C diff
  • tendonitis and tendon rupture
  • neuromuscular blockade
  • CNS side effects
  • rashes and phototoxicity

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:

After just one dose, he developed widespread pain and weakness … But the next pill, he said, “eviscerated” him, causing pain in all his joints and vision problems. In addition to being unable to walk uphill, climb stairs or see clearly, his symptoms included dry eyes, mouth and skin; ringing in his ears; delayed urination; uncontrollable shaking; burning pain in his eyes and feet; occasional tingling in his hands and feet; heart palpitations; and muscle spasms in his back and around his eyes.

It’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 here.

But I wonder — are they truly more dangerous than other antibiotics? Or is this a matter of heavy usage of relatively new drugs, hence more notoriety?

What do you think?

True or False: Fluoroquinolones are more dangerous than other antibiotics.

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30 Responses to “Are Fluoroquinolones Really More Dangerous Than Other Antibiotics?”

  1. Marcos Margarit says:

    Nice reflection. The questions, I think, is a little bit ambiguous. The fact is that the hepatic failure because of clavulanic is a more frequent serious side effect than that of FQ, because A/C is more frequent used (at least in Spain).
    There are a lot of efforts in reducing the antibiotics prescription, but I think that there is still a big margin for it. Reducing the use for common diseases that even been bacterial, the ATB don´t suppose a big advantage, can be not only a good way of reducing sanitary bill, but also a boost to improve the efficacy of the ATB. At least in primary care, the better selection seems to reduce resistances… But there is a long journey ahead: I have companions that prescribe cefixima for a sore throat or an uncomplicated UTI in children…

  2. Mel Breite says:

    levauin is the new z-pak as in “Ihave a cold (or earache or sore throat or whatever). Give me a z-pak).”
    So what’s going to happen when we get more kiosks in pahrmacies with NP’s and PA’s who woek for the pharmacy?

  3. L.Saxinger says:

    Paul, interesting piece! Just pointing out that pedagogically, the T/F description options offered aren’t exclusive – that is, one can agree with elements of both. A slightly flawed evaluation tool…(I am an ID doc, with extra interest in AMR, and in education-evaluation. Pretty geeky I know.)

  4. Thomas Benzoni says:

    I think the real problem is in the prescribing of antibiotics.
    I work in a busy ER. Every day I see patient’s with side effects of antibiotics.
    many have been given an obvious viral diagnosis and an antibiotic prescription.
    Some are given a pseudo diagnosis (elevated WBC is typical) and prescribed.
    I do not buy that the patients are pressuring us; this is blame the victim mentality.

  5. Fluoroquinolone Antibiotics are absolutely more dangerous than other antibiotics. Here’s why:
    1. The injuries can be long lasting and debilitating, and require expensive surgeries, hospitalizations, physical therapy to get over. The ADRs, (adverse drug reactions) can be so damaging that your life can turn on a dime with long term, (months, years), or permanent disability. Cartilage tears, ruptured tendons, neuropathies, optic tendon damage, central nervous system injury, causing sleeplessness, hallucinations, and other mental changes.
    2. With other antibiotics, side effects will manifest during the taking of the drug and usually stop with the cessation of the treatment, even if severe. Not true with Fluoroquinolones. It is common to have NO side effects during a course of Fluoroquinolone Antibiotics, but, be blindsided a day, week, month after the cessation of the drug with Achilles tendon rupture, for instance.
    3. These drugs change the DNA of the pathogen to keep it from replicating, unlike other antibiotics in the past, which got in your system and killed off the pathogen. Once inside the body, as little as one pill can cause damage to human tissue, other than the pathogen, and there is NO test to take prior to ingesting a Fluoroquinolone to see who will be damaged and who will not, or to what extent. It is literally like playing Russian Roulette with your body’s functioning.
    4. You can have 1 or 2 successful treatment courses with a Fluoroquinolone and then on the 3rd course, end up permanently injured, disabled. More of these drugs have been pulled off the market, than are currently in use due to their dangers.
    5. Disturbing animal trials, prior to clinical trials, showed inhibited cartilage growth and damaged cellular repair mechanisms, after only one dosage in all sacrificed canines. Manufacturers new these drugs were dangerous from the get go. It has been up to the injured population, of which there are tens of thousands, (and climbing,) to try to figure out how to cope with the severe onslaught of adverse events associated with these drugs. After citizen petitions, one resulting in a lawsuit against the FDA, two Black Box warnings have been issued for the Fluoroquinolones that are still on the market. One in 2008 for tendon rupture, and the warning last year for people with Myasthenia Gravis to avoid taking these drugs. In 2011, the Mayo Clinic study on Fluoroquinolone Use in the Athletic Population, determined that NO athlete should be given a Fluoroquinolone Antibiotic, unless there was no other course of treatment possible.

  6. GN, PA-S says:

    I’ve even seen cipro and levaquin be used for cellulitis. Can anyone please explain to me why?!?!?

  7. Deborah Titley says:

    I am a nurse…and someone who has not only experienced several of those debilitating side effects that are supposed to be rare(beginning with a painful spontaeous achilles tendonitis. Also repeatedly witnessed suspicious symptoms in patients….especially the elderly.
    In the medical and care giving community it is not uncommon to be dismissive of symptoms that present because they often are quite delayed and the patients are not always good historians… difficult to connect the dots…..and easier to be dismissive. It would seem that there has been A LOT of untold pain and suffering connected to this group of antibiotics.

  8. Aruna Poojary says:

    I am a clinical microbiologist and for me the wide spread use of Fluoroquinolones has caused us the problem of drug resistance.

    Apart from a few patients who may have experienced mild CNS symptoms , I have not encountered serious side effects despite their widespread use/abuse.

  9. Jihoon Baang says:

    I am an ID doc and was recently involved in the management of MDR tuberculosis in a part of the world where this disease is heavily endemic. Levo was a routine prescription and patients would take them for almost two years. Some would complain of joint pain but we would give them NSAIDS and continue because there were no other options. I had one patient complain of CNS symptoms but we had no choice but to continue. And in the end they were cured of their TB. The point is, FQs are not evil drugs. They are drugs with side effects like any other drug. It is important to know these side effects, properly inform our patients and manage their expectations. But I think it is unwise to demonized a drug and make it look like an “evil” drug.

  10. Cathy says:

    And I’m NOT an ID doc or a nurse…just a lowly patient. I will never take another fluroquinolone after 4 days of Cipro left me with Achilles tendonitis so severe that I was on crutches for months. No one warned me this was a possible side-effect. It was only when I went online (a big no-no, I know) that I made the connection and stopped the drug. I still have persistent inflammation and pain. Is that an acceptable risk to take to treat a nasty UTI? I think not!

  11. Murugan Sankaranantham says:

    Eruptions, especially Fixed Drug Eruptions, are more common with Fluoroquinolones than with other antibiotics in my experience.

  12. Kelli Chan says:

    I took Levaquin 500 mg daily for a week 27 months ago and am still suffering the debilitating effects of this drug. Tendinopathy throughout my body, peripheral neuropathy, damage to my central and autonomous nervous systems, vision problems, GI problems, heart and lung problems. I have spent tens of thousands of dollars for treatments, am stuck in my house, suffer immense pain daily. Given the debilitating, costly, long-term (even permanent) effects of these drugs, there is no question that they are more dangerous than other antibiotics. If anyone disagrees, please name the antibiotic that causes more long-term and permanent multi-system effects than fluoroquinolone antibiotics do.

  13. Barbara says:

    Fluorinated Drugs
    Many prescription drugs contain a hidden dose of fluoride. Several fluoride-containing medications have been banned because they caused death and illness. Fluoride is highly toxic to the liver. In the liver, fluoride interferes with the metabolism of thyroid hormones; it creates thyroid disorders and associated diseases that affect muscles, heart, immune system, etc. Many psychiatric drugs contain fluoride. Siliconfluoride is linked to antisocial behavior in youth. The fluorine atom is attached to the active ingredients in many drugs in order to allow them to cross the blood-brain barrier and enter the brain or other organs more readily, so less of the active ingredient is needed, and more money is saved by the pharmaceutical manufacturer. But the side effects of all these fluoride-containing drugs are rarely known or discussed as health issues.

    The fluorine ion is an enzyme inhibitor. The one side effect common to fluorinated drugs is memory loss. These drugs, including Prozac (fluoxetene)–and Paxil–antidepression drugs, contain three fluorine atoms in each molecule that kill enzymes in the brain that normally maintain mood stability.

    Prozac and Paxil contain Fluorophenyl compounds which contain fluoride and cause liver disease.. Organic fluorides are transformed in the liver, and the resulting metabolites can have higher activity and/or greater toxicity than the original compound. Prozac can cause hepatitis and promote tumors in the liver. Rophypnol (flunitrazepam)–the date rape drug–is essentially fluorinated Valium, which is 20-30 times more potent than Valium. Phen-Fen (Fenfluramine) a weight-loss drug, fluorinated corticosteroids contains fluoride. People taking such drugs might exceed 5 mgs. in just one prescribed application.

  14. Barbara says:

    I think this part needs bold face… The fluorine atom is attached to the active ingredients in many drugs in order to allow them to cross the blood-brain barrier and enter the brain or other organs more readily, so less of the active ingredient is needed.

  15. Barbara says:

    If you have a MTHFR gene defect or any other methylation defect you will probably be one of those people who gets a bad side effect. I agree with the other poster who said that taking FQ’s are like playing Russian Roulette. I was diagnosed with one of the MTHFR gene defects after I took Cipro and now I am paying the consequences. i never would have taken it if I had known what it is. Then gave it to me for a UTI… off label and hardly a last ditch effort to save my life because nothing else was working !

  16. T formerly of Clev Clinic says:

    Reader comments illustrate a MAJOR disconnect between the FDA, Rx companies and doctors. The FDA has been made aware of the permanent, debilitating adverse reactions to all quinolones – the Rx companies, of course, know about these dangers and downplay them. Physicians, for the most part, do not know of, admit to, or even seem to fathom these reactions – which leads me to believe that they are purposely kept in the dark or that their egos will not allow them to admit the damage that these drugs are capable of. There are many support groups for quinolone victims on facebook – the largest has well over 2,000 members and grows larger daily. If you have been affected by quinolone adverse effects, I suggest you search ‘fluoroquinolone toxicity’ on facebook for support and knowledge. I was on staff at a major teaching hospital in the midwest. Due to damage done to my hands from five days of Cipro, I have lost the ability to practice my profession – not to mention an immeasurable hit to my quality of life. Before Cipro I was fit and active – 2 years post Cipro I am unable to hike, play sports, work with my hands, and have difficulty playing musical instruments I once played with ease. The reaction from former colleagues has ranged from disbelief and denial to a reluctant admission that Cipro can do these things qualified by a “good thing it is so rare”. Admission of quinolones causing these issues is denied by most doctors to their patients – mine were convinced only after I exhaustively documented all the research and tested negative for every other possible explanation – and I was a professional colleague. I find that what is rare is a physician’s willingness to accept the truth about these drugs.

  17. erin says:

    These drugs are dangerous. The doctors that over use and abuse them are dangerous as well. I am a victim of these drugs and I know thousands of people who have been damaged from one RX as well as people who are dying because they were given 20 rounds of these drugs. Go ahead, keep taking them and I’ll eventually get to know you when you are on a recovery board and dying from using an antibiotic like Cipro, Avelox or Levaquin. These drugs kill bacteria, and a lot of other things like your happy, normal life.

  18. Brian Garrett says:

    I was prescribed Cipro bak in January for a UTI. Took one dose and got pins and needles in my feet. After reading that this is a serious side effect, I called the doctor and was told to go ahead and take the next dose at the scheduled time as there was very little chance it was connected with the Cipro. So I did, and the pins and needles came back, worse than ever. Called the dr. back and she switched me to Bactrim, but the damage had been done. The pains went into my achilles tendons the next day, and had affected my hamstrings by the time the week was up. Would have undoubtedly spread through my body if I had not started going for treatments at an alternative health clinic. Eight months of expensive treatments (not covered by insurance) and physical therapy later, I think I’m finally on the mend. When will doctors stop being lap dogs for Big Pharma and consider the risks before prescribing dangerous meds for non-life-threatening conditions? If my doctor had started me on Bactrim from the get-go, I’d be fine now.

  19. Jonathan Q says:

    Believe me they are dangerous. I was given levaquin last year and within 3 days my right arm became weak. And on my 5th pill my legs/arms started burning and my calves became very tight. my doctor told me to stop taking the medicine and said I would be fine in a few weeks.

    Following this about 2-3 weeks later my quads started having stabbing pains. my arms were having random pains and weakness that i had trobule brushing my teeth some days. My knees and achilles tendons swelled up. I had all sorts of random muscular/tendon pain throughout the body. My eyes went dry, and I started developing floaters about 3 months after stopping the medicine. My foot started having all sorts of issues about 1 month after stopping the medicine, i had symptoms of plantar fasciaitis to burning stabbing pains all over the foot.

    Eventually the random pains and burning went away but my eyes are still dry, i still ahve floaters. i have joint laxity, flat feet, hyperpronation, knee cartilage damage. I require a brace or orthotic at all times to walk around. My feet are literally falling a part, even walking for 10 mins is an issue. I am unable to live a normal life.

    I’ve been to over 30 doctors and none can find out exactly what it did to my body besides after about 3 – 4 months of going to doctors they started doing MRI and XRays again and started noticing all sorts of damage showing up.

    These antibiotics should be used as a last resort. My doctor even admits I did not need an antibiotic at all, I went in for simple armpit pain that did not go away after 2 weeks they did XRay she said well I am not sure what that is but i think you could have pnemonia but I had no symptoms. she said it’s best if you just take this antibiotic so I did. And no one warned me of anything. Then when I did finally read the fine print it’s all burried like 8 lines deep that says if you get burning stop taking hte medicine. really? they said things like it could cause headache, drowsiness or other crap and then burried the “burning” all the way down. And then it says it could cause pemenant damage to nerves if you don’t stop taking the medicine.

    I’ve found most of my doctors have no clue that levaquin can cause tendonitis let alone nerve damage and CNS issues. There are so many complaints after I did a quick search on the internet.

    You know at one point or another you gotta remember we are human beings and doctors need to start looking at patients complaints. And stop the bickering that they know everything. It’s not breaking news that pharma companies goal is to make money and they aren’t always 100% truthful about side effects and our FDA is funded by pharma more than by tax dollars.

    My life is ruined and my bank account is empty… all life savings gone. i have pain just gettin gout of my bed to go to the bathroom now. from just 5 pills. I went from healthy to sitting around on my couch with dilitating pain.

  20. Jonathan Q says:

    I’d like to add a few more things to what I said…

    1) quinolones should not be banned, rather used properly and side effects should be noted to doctors.

    2) I had taken levaquin and cipro about 4 years prior to me having this reaction this time around. Previously I had no issues from taking quinolone. Before that I don’t believe I had ever taken it.

    3) I have spoken to my pharmacist on my work campus, who told me that I am not the only one that has came into tell him such side effects. In the past 2 years he’s been in our company he said he’s had 8 or 9 people come talk to him about their issues after taking quinolones. He now warns patients heavily to stop taking it if any burning or muscle/tendon or joint pain occur. He also asks them to ask their doctors to make sure they can’t give them something else instead.

    4) FDA has received over 23,000 complaints alone on Levaquin. Clearly not all of these are severe affects but plenty say “disabled” as a direct result.

    5) While all drugs have side effects, problem with quinolone is it literraly feels like it’s tearing your body down and you have no clue what to expect. Even after you stop the drug. It stops the person from functioning really. Not being able to cook, to even walk to their bathroom. This is pretty SERIOUS.

    6) There are thousands of stories online of people having major side effects like this to quinolone antibiotics. I don’t believe it’s common yet it’s also not “rare”.

    7) Research must be done to see what causes people to have these side effects. When they take it one time and nothing. They take it again and side effects.

    8) They should reserach what it’s doing and what should be done to help stop these side effects from becoming body wide spread. These companies have made billions, they can at least do some research to figure out what their product has done to their customers.

  21. Simon says:

    I have never had a problem with any antibiotic until Cipro. Cipro took my active/athletic life away. I now battle chronic tendinitis which makes even walking difficult at times. It has been over 5 years now. I have made some progress however the system wide tendinitis is not going away. My joints hurt and prevent me from doing anything physical. I have been tested for everything – no RA etc. This all started, or should I say ended, when I had a severe reaction to Cipro. This antibiotic is poison to me.

  22. Greg Spooner says:

    I think a plausible answer to this question is evidenced by the fact that almost two thirds of all FQs have been pulled from the market or curtailed due to severe ADRs (ie: Tequin, Trovan, etc.). When we look at other families of antibiotics (for instance, that of penicillin) we find none have been withdrawn. When we also note that FQs have only been used for about 2 decades, and the penicillin class has been used for nearly 3 times longer (yet has a much safer profile), I think one begins to see that this class of antibiotics is indeed less safe.

  23. Chris says:

    This drug is responsible for 5 tendon tears and ulcerative colits along with other problems. My body started rejecting other antibiotics after being prescribed Levaquin and Avelox last year. Wide spread publicity? I think not. The mechanism by which these drugs act make them significantly more dangerous than any other antibiotic on the market. How many deaths have been attributed to this drug? I believe so far @2,500 people have died as a result of taking them. How many people have died taking amoxicylan?

  24. jane says:

    These quinolone drugs ruin lives, finances and relationships. You come to think of your life as before and after levaquin or cipro No where on the black box warning does it warn about that. No where does it warn that it is NOT rare. The FDA has done a crapy job of protecting patients but of course the major concern of the FDA is about profit.

  25. Alice says:

    Have you seen a young, active person go from perfectly fine (albeit with a suspected prostate infection) to bedridden in one day from one pill? It happened to my boyfriend three months ago, and he is still terribly debilitated.

    As far as I know, no other class of antibiotics has prompted the formation of huge online support groups and a non-profit research foundation to help victims. You can tell me these drugs are just as safe as other antibiotics until you’re blue in the face, and I’m telling you these drugs are not worth the risk unless there are no other options.

  26. Rose Terry says:

    I’m sitting here up most of the night with severe pain yet again. I have Periperal Neuropathy thoughout all my limbs and it can be absolutely horrible. All due to taking Levaquin. Yes I speak from experience that Fluoroquinolone antibiotics can be really terrible!

  27. Caroline Brinkley says:

    All I can say is I only had c. diff once. It was after the third day of levaquin for sinusitis after influenza. Really makes me reluctant to prescribe them unless patients are allergic to anything else.

  28. Mukesh Kumar says:

    I have been using FQ since I joined medical practice approximately nine years ago and found them very good in my routine clinical practice.
    In my experience, FQ use has been associated commonly with minor allergic reactions(especially when given intravenously), tendinitis and drug eruptions.
    Moreover, they are a wonderful class of drugs and they should be prescribed with proper justification, as rampant use of these potent drugs may make things worse in areas with heavy incidence of MDR Tuberculosis, in a country like India(where I practice currently).
    They should not be banned.

  29. karen Hill says:

    Mukesh Kumar: These drugs are dangerous and should be prescribed only in a hospital setting as a LAST resort. They are radical and have given me severe reactions and I am thinking about a lawsuit myself. So, to the Doc that posted: Mukesh Kumar,,You be sure and take some of that awesome FQ on your next round illness eh! And happy trails to you hope it doesn’t cripple or blind you!

  30. Pamela says:

    I think the question was answered Aug 15, when the FDA announced yet another required label update to all quinolones. It found that yes, quinolones can cause permanent nerve damage, and yes, the drug makers downplayed it. An L.A. firm is plaintiff-seeking anyone who experienced these horrors. It just keeps getting better for J&J and Bayer.

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