Adverse effects of fluoroquinolones

Fluoroquinolones are a class of antibiotics used to treat a variety of bacterial infections. While they can be highly effective, they are also associated with a range of adverse effects. Understanding these effects is essential for healthcare providers to make informed decisions and to ensure patient safety.

Introduction

Fluoroquinolones are a group of broad-spectrum antibiotics that include drugs such as ciprofloxacin, levofloxacin, and moxifloxacin. They are commonly prescribed for the treatment of various bacterial infections including respiratory, urinary tract, and gastrointestinal infections^[1].

Mechanism of Action

Fluoroquinolones work by inhibiting the bacterial enzymes DNA gyrase and topoisomerase IV, which are essential for DNA replication and transcription. This inhibition leads to DNA damage and ultimately, bacterial cell death^[2].

Common Adverse Effects

Common adverse effects of fluoroquinolones include:

• Nausea
• Diarrhea
• Dizziness
• Headache
• Photosensitivity (increased sensitivity to sunlight)

These side effects are often mild and may not require discontinuation of the medication.

Serious Adverse Effects

In addition to the common adverse effects, fluoroquinolones have been associated with several serious adverse effects:

• Tendonitis and tendon rupture: Fluoroquinolones can cause inflammation and even rupture of tendons, most commonly the Achilles tendon.
• QT interval prolongation: These antibiotics can prolong the QT interval on an ECG, potentially leading to life-threatening cardiac arrhythmias such as Torsades de Pointes.
• Peripheral neuropathy: Fluoroquinolones can cause damage to peripheral nerves, leading to pain, tingling, or numbness.
• Central nervous system effects: Some patients may experience confusion, anxiety, and hallucinations.
• Clostridioides difficile infection: Like many antibiotics, fluoroquinolones can disrupt the normal bacteria in the gut and lead to an infection with C. difficile.

Risk Factors

Certain individuals are at a higher risk of experiencing adverse effects:

• Older age
• Concomitant corticosteroid use
• Kidney disease
• History of cardiac disease
• History of tendon disorders

Regulatory Actions and Black Box Warnings

The U.S. Food and Drug Administration (FDA) has issued several communications and “black box” warnings regarding the risks of fluoroquinolones. In particular, they have warned about the risks of tendinitis, tendon rupture, and worsening symptoms for those with myasthenia gravis^[3].

Patient Education and Monitoring

Healthcare providers should educate patients on the potential side effects of fluoroquinolones and advise them to seek medical attention if they experience severe pain, changes in sensation, or unusual psychiatric symptoms. Monitoring may include regular assessments for signs of tendinitis, electrolyte monitoring for QT prolongation, and monitoring for signs of C. difficile infection.

See Also

• Fluoroquinolones
• Antibiotics
• Pharmacovigilance

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