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  • 2017-03-22 (xsd:date)
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  • Could Cipro and Other Fluoroquinolone Antibiotics Cause Irreversible Tendon Damage? (en)
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  • On 18 March 2017, the author of a blog called Mountains and Mustard Seeds published a post about her personal experience with serious medical complications caused by a class of antibiotics called fluoroquinolones. These drugs include: That post (headlined This Antibiotic Will Ruin You) highlights somewhat recent announcements made by the FDA requiring new warning labels and suggested limitations on their use: While our post does not seek to verify the author's personal story, the information presented regarding documented complications from this class of antibiotics is factual. The Food and Drug Administration, since July 2008, has issued a series of increasingly strong notices regarding the rare (but serious) risk of tendon rupture, tendonitis, and neurologic damage resulting in pain or numbness. These alerts culminated in a revised Boxed Warning and new prescribing recommendations, as described in a 26 July 2016 FDA safety announcement: As a 2015 review of adverse effects from fluoroquinolone antibiotics explained, the class of drugs has a long history of use for a broad range of conditions, and uses a unique mechanism that actively destroys bacterial DNA: That same report, which used data collected by the FDA’s Adverse Event Reporting System (FAERS) to demonstrate the reality of these risks, stated that while the exact mechanism by which fluoroquinolones may contribute to tendon damage is unclear, it does likely involve mitochondrial damage as described in the Mountains and Mustard Seed post: In other words, the drugs cause damage to, and sometimes kill, tendon cells by overproducing oxygen-containing chemicals, and can also harm a cells vital mitochondrial DNA. To be clear, the risks are still somewhat rare. Depending on which drug is used and what studies you base your analysis on, tendonitis and tendon rupture are estimated to occur in 0.14 percent to 0.4 percent of cases, though experts agree the true incidence is likely higher due to underreporting. According to multiple studies, these risks are higher in elderly populations, non-obese populations, and especially patients also prescribed glucocorticoid steroids, which are used to treat inflammation, among other things. Because of the potentially permanent and disabling effect of these risks, the FDA argues, the risk-to-benefit ratio has shifted enough to merit limiting their prescription to cases of absolute necessity, per their July 2016 notice: The author of the Mountains and Mustard Seeds post also alluded to potential psychiatric complications: This, too, is accurate, although the recent changes to FDA warnings were not spurred by any new incidents or developments regarding mental health events. A 2003 study using data collected by the Italian government estimated that psychiatric effects from fluoroquinolones occur in about 1.8 percent of cases, with a majority of those cases being minor and self-resolving. Ultimately, any drug comes with potential adverse effects and discussing those risks versus the potential benefits with a doctor is wise. In the case of fluoroquinolones, there are indeed serious risks that need to be considered, especially when other classes of antibiotics may be effective. (en)
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