Fluoroquinolones, adverse reactions

Discuss the uses, general drug action, contraindications, precautions, interactions, and adverse reactions of the fluoroquinolones and aminoglycosides. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of a fluoroquinolone or aminoglycoside. 

The more common adverse effects seen with the administration of these dm include nausea, diarrhea, headache, abdominal pain or discomfort, and dizziness. A more serious adverse reaction seen with the administration of the fluoroquinolones, especially lomefloxacin and sparfloxacin, is a photosensitivity reaction. This is manifested by an exaggerated sunburn reaction when the skin is exposed to the ultraviolet rays of sunlight or sunlamps. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

The data on the adverse reactions of the fluoroquinolones which have received the most extensive clinical evaluation (ciprofloxacin, ofloxacin, pefloxacin, norfloxacin and enoxacin), involving about 30,000 patients, have been the subject of a review [54a], An important point noted in this review involves the difficulty in detecting an important severe adverse reaction if it is of relatively low frequency, until there has been a very large patient exposure (some examples are provided in which at least 150,000-300,000 exposures would be required to observe the importance of side-effects, resulting in an alert, which have been discovered with specific drugs). However, the majority of side-effects observed thus far with the fluoroquinolones have been minor,... 

The frequency of adverse reactions to the topical ophthalmic fluoroquinolones is low. The most frequently reported adverse reactions to ciprofloxacin are local burning or discomfort after instillation, bitter taste after... 

Jolson HM, Tanner LA, Green L, Grasela TH Jr. Adverse reaction reporting of interaction between warfarin and fluoroquinolones. Arch Intern Med 1991 151(5) 1003-4. 

Bowie WR, Willetts V, Jewesson PJ. Adverse reactions in a dose-ranging study with a new long-acting fluoroquinolone, fleroxacin. Antimicrob Agents Chemother 1989 33(10) 1778-82. 

Adverse effects might be produced when fluoroquinolones are administered with other medications. Here are potential adverse reactions ... 

Risks of using tetracyclines and fluoroquinolones in children must be weighed carefully against the risk for developing a life-threatening disease due to B. anthracis. Both agents can have adverse health reactions in children. If adverse reactions are suspected, theiapy may be changed to amoxicillin or penicillin. 

One of their major classes of drugs, quinolone antibiotics, is associated with serious problems such as the syndrome of hemolysis. In some cases, uremia, coagulopathy, and hyperbilirubinemia were observed for fluoroquinolone antibiotics like temafloxacin. Other adverse reactions have also been reported on the central nervous system with symptoms of headaches, insomnia, and dizziness. Skeletal problems still remain theoretical for quinolones in the prenatal formation, but tendinitis and tendon rupture have occurred in small number of adult patients. " ... 

Adverse reactions to levofloxacin from 1980 to 2009 have been reviewed in comparison with other fluoroquinolones [34 ]. Levofloxacin should have a relatively low... 

Susceptibility factors Children The evidence for quinolone-induced arthropathy in children has been reviewed [33 ]. Data from animal studies and case reports, including tendon-related adverse reactions seen in adults, support a policy of restricting the use of fluoroquinolones in children and adolescents. The emergence of fluoroquinolone-resistant pneumococci is another reason for restricting their use. The authors cited statements from the American Academy of Pediatrics on cases in which... 

Fluoroquinolones, 12.250, 18.271 Fluorouracil, adverse reactions, 23.476 Folic acid, dietary supplementation, 19.369 safety aspects, 27.407 Formoterol, tolerance, 24.187 Fragrances, contact allergy, 20.149... 

Monitoring and Managing Adverse Drug Reactions Fluoroquinolones... 

Leone R, Venegoni M, Motola D, Moretti U, Piazzetta V, Cocci A, Resi D, Mozzo F, Velo G, Burzilleri L, Montanaro N, Conforti A. Adverse drug reactions related to the use of fluoroquinolone antimicrobials an analysis of spontaneous reports and fluoroquinolone consumption data from three Italian regions. Drug Saf 2003 26 109-20. 

Owing to adverse effects (including severe anaphylaxis, OT interval prolongation, and potential cardiotoxicity), several fluoroquinolones have had to be withdrawn (for example temafloxacin and grepafloxacin) or strictly limited in their uses (for example trovafloxacin) after marketing. A serious idiosyncratic reaction profile is possibly related to the immunologically reactive 1-difluorophenyl substituent that characterizes temafloxacin, tosufloxacin, and trovafloxacin (7). 

Photosensitivity is a common adverse effect of the fluoroquinolones. It results from an abnormal reaction of the skin to natural or artificial light sources, usually associated with the UVA part of the electromagnetic spectrum (315-400 nm), mediated by the absorption of light energy into fluoroquinolones, followed by degradation of the molecule and formation of cytotoxic photoproducts (64). 

The adverse effects rates of levofloxacin are 1.3% for nausea, 0.1% for anxiety, 0.3% for insomnia, and 0.1% for headache. No levofloxacin-related adverse events were reported at a rate higher than 1.3%, and most were less common. High-dose levofloxacin (750 mg) was also well tolerated. Surveillance data reported low adverse event rates nausea 0.8%, rash 0.5%, abdominal pain 0.4%, and diarrhea, dizziness, and vomiting 0.3%. The adverse drug reactions rate for levofloxacin is stiU one of the lowest of any fluoroquinolone, at 2% compared with 2-10% for other fluoroquinolones (6-9). 

Anaphylactic and anaphylactoid reactions are rare adverse events after the administration of fluoroquinolones (about 0.46-1.2 per 100 000 patients). 

The newer fluoroquinolones (ciprofloxacin, norfloxacin, enoxadn, pefloxacin, gatifloxadn and moxi-floxacin) have similar toxicities and incidence of adverse effects. In general, compared to other antibiotics, these are relatively safe agents [190]. Gastrointestinal side-effects are the most common (0.8 to 6.8% of patients), followed by central nervous system manifestations (0.9 to 1.8%), and skin reactions (0.6 to 2.4%). Rare cases of increased serum creatinine levels have been reported [203]. Indeed, in a study of 133 febrile episodes in neutropenic patients comparing the effectiveness and safety of high-dose oral ciprofloxacin versus azlociUin and netilmicin, there were no renal ad-... 

Nervous system The adverse effects of antituberculosis drugs on the nervous system have been reviewed [1 ]. Isoniazid is most often associated with nervous system reactions, most prominently peripheral neuropathy, psychosis, and seizures. Optic neuropathy can occur with ethambutol and ototoxicity and neuromuscular blockade with aminoglycosides. Cycloserine can cause psychosis and seizures, and the psychosis in particular limits its use. Fluoroquinolones are rare causes of seizures and delirium. Significant neurotoxicity has not been documented with newer forms of therapy under development. 

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