Antibiotic treatment - adverse effects and risks: the case of quinolones

20.09.2019
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Antibiotic treatment - adverse effects and risks: the case of quinolones

It was always recommended that the antibiotic treatment should be performed under strict medical supervision.

Compliance with this recommendation has become more and more necessary lately.

This happens because new data only amplify the reasons why antibiotics must be both prescribed and performed under strict medical supervision.

It has been acknowledged until now that antibiotics abuse, often for mild infections that could be controlled by other means, or without any antimicrobial susceptibility testing (which could certify that the germs responsible for the infection are susceptible to the antibiotic administered), may lead to the "resistance" phenomenon. As a result of this phenomenon, more and more germs have become increasingly resistant to more and more antibiotics.

Quinolones are a class of broad-spectrum bactericidal antibiotics, most of which have the fluorine atom in their structure, whose bactericidal action is manifested both on Gram-positive and Gram-negative bacteria.

One example is Ciprofloxacin, one of the most widely used antibiotics worldwide.

Another example is Levofloxacin (Tavanic), also very commonly administered to hospitalized patients as well as outpatients.

In fact, starting with 2002, quinolones have become the most prescribed antibiotics in the world for adults.

Indications were primarily urinary and respiratory tract infections, but also sinusitis, otitis, and infections of the digestive tract.

The antibiotic resistance phenomenon hasbeen recorded for quinolones, of course, for many pathogens, including Escherichia coli; recent cases of campylobacter or salmonella resistant to quinolones have been reported.

On the other hand, however, the phenomenon that has become more and more disturbing over the past few years is that of the toxic effects of quinolones.

Toxic effects have been known from the start: tendinitis associated with the risk of tendon rupture, central nervous system disorders (insomnia, nervousness, sometimes seizures or even psychotic episodes) and the peripheral nervous system (in some cases irreversible), increased risk aortic dissection, cardiac toxicity (QT prolongation time, associated with severe arrhythmia risk), the risk of intestinal infections with Clostridium difficile.

There are authors who even state that excessive administration of quinolone is the most important risk factor in the development of diarrhea associated with Clostridium difficile, an infection that makes real damages in today's hospitals.

However, the risks associated with the administration of quinolones were initially considered relatively small and substantially outweighed by the benefits of many serious infections.

But over time, it was found out that the adverse effects on quinolones were much more serious than thought at first, outweighing the potential benefits.

Therefore, in 2015, the Food and Drug Advisory Committee (FDA) recommended limiting quinolone indications to low or medium severity infections (uncomplicated urinary tract infections, acute sinusitis, acute bronchitis), trusting that in these cases the risk of serious toxic effects outweighs the potential benefits.

As Mahyar Etminan, a pharmacologist at the University of British Columbia, quinolones are drugs that have been used excessively by "lazy doctors trying to kill a fly with a nuclear weapon"

In May 2016, the FDA comes back with a statement that quinolonetreatment should be reserved for those infections in which there is no other therapeutic option.

In July 2017, the FDA issued a new release warning about the major toxic potential of quinolones and recommended their use only as a reserve treatment line for sinusitis, bronchitis and uncomplicated urinary tract infections.

At present, very clearly documented toxic effects of quinolones have made them to be considered the most dangerous antibiotics on the market, and their effects may sometimes be considered deadly.

In the United States, thousands of trials are being reported annually against Levaquin (Tavanic in Romania) due to severe side effects: retinal detachment, hallucinations, psychotic reactions, renal failure, peripheral neuropathies, etc.

That's because the severe side effects mentioned above occur in young, healthy, active people for whom the antibiotic has been prescribed for mild infections.

The main culprit for these toxic effects is considered to be the fluorine that can cross the blood-brain barrier and whose adverse effects are primarily manifested in the central nervous system.

Medicines are considered to be particularly dangerous for children under 18, adults over 60 years of age and pregnant or breastfeeding women, for people with liver disease, those undergoing corticosteroid therapy or non-steroidal anti-inflammatory drugs.

It is somewhat weird that, despite the numerous alarm signals in the last 10 years, the use of quinolones continues to be as widespread. It has come to the situation that sometimes patients are the ones who call the doctor's attention to the potential toxic effects of the prescribed antibiotic. The Internet has already formed a community of those who have suffered from the toxic effects of fluorine quinolones and the number of these people who call themselves “Floxies” continues to grow.

In an age where information travels very quickly and on multiple paths, we believe it is time, together with doctors and patients, to find solutions to limit the administration of a category of extremely high potentially toxic antibiotics.

Prof. Irinel Popescu is a prominent surgeon and a member of the Romanian Academy of Sciences. He is a leader in surgical oncology and liver-related medical procedures. For the last three decades, Prof Popescu has been the pioneer and motivator of liver transplants in Romania and the founder of a Romanian school for liver transplantation.
Prof. Popescu is a social contributor in raising the public awareness for organ donation, which Romania is still showing a very sluggish progress in.
He is a member of many local and international medical associations and a respectable writer and speaker in the most important medical and surgical conferences.
Prof. Popescu serves as the President of the Romanian Academy of Medical Sciences and as a Corresponding Member of the Romanian Academy.


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