Cipro and Fluoroquinolone update

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The UK medicines watchdog has issued guidance on fluoroquinolone antibiotics following some reports of ‘potentially irreversible’ side effects affecting multiple systems, organ classes and senses.

The Medicines and Healthcare Regulatory Authority (MHRA) cautioned healthcare professionals on 21 March against prescribing the drug and to advise patients to stop taking it if they

experienced side effects including muscle pain and peripheral neuropathy.

This is part of new restricted indications following an EU-wide safety review of the drug following

‘relatively few’ reports of serious side effects usually affecting the musculoskeletal and nervous systems. It is likely that the number of those adversely affected by the drug has been under-reported, the MHRA said.

Taking fluoroquinolone – which is prescribed for serious, life-threatening bacterial infections – by mouth, injections or inhalation can ‘very rarely’ cause these side effects for up to months or years, according to the MHRA.

It should not be prescribed for mild to moderate infections unless other antibiotics are considered

inappropriate.

Some of the serious side effects reported include tendon rupture, depression, fatigue, memory impairment and arthralgia.

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  • Posted

    The new NICE guidelines say that for acute prostatitis a doctor must first establish whether there is an infection by urine culture or other symptoms. The guidelines say to start treatment while waiting for culture results if an infection is suspected . A two week course of an antibiotic should be given (which is down from the previous 4 - 6 week course). The guidelines say that Ciprofloxacin or Ofloxacin (fluoroquinolone antibiotics) are usual but I would caution here that these can have very severe side effects (see the fluoroquinolone antibiotic thread on this site. The guideline says two weeks of Trimethoprim can be given instead and I would advise asking for this - save the fluoroquinolone for if you are really seriously ill.

    For chronic prostatitis the guidelines no longer recommend a fluoroquinolone and say Trimethoprim 4-6 weeks or Azithromycin 3 weeks should be given.

    To all those guys whose lives have been ruined by long courses of Cipro or other fluoroquinolones I can only apologise that these guidelines have been changed too late. Hopefully not so many more men, young or old, will be damaged by these drugs in the way that you were.

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    • Posted

      My wife had a neurology appointment yesterday. I took the opportunity to ask him if there was any point in my making an appointment to see him about my Cipro/ fluoroquinolone problems having already seen two who could not help. He said he regards Floxed people in the same category as those who have problems after having had chemotherapy and can do nothing for them.

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    • Posted

      This is typical - they cause you serious problems with their 'approved' drugs then say there's nothing they can do for you afterwards. The EMA spent 2 years looking at the seriousness of the fluoroquinolone side effects including the danger of permanent disability and they have declared them safe to take, so that's alright then?

      If you're one of the thousands who have got persistent and possibly permanent damage (or even one of the many thousands who have no idea why they have these problems) - tough.

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    • Posted

      From a pharmacist.

      A young man comes to your pharmacy counter in a wheelchair. He slowly stands up and says, “Don’t worry, I’m not paralyzed, I just had multiple surgeries on both legs. I had a few torn tendons, but I’m getting better.”

      He hands you a prescription for hydrocodone/apap 5/325 1-2 q6h prn severe pain #30. It is written by an orthopedic surgeon. You ask the patient if all his information is current and if there are any new drug allergies. He says that his orthopedic doctor told him to tell you he is allergic to ciprofloxacin (Cipro). He was instructed to never take ciprofloxacin ever again. You ask him if he developed a rash or difficulty breathing. He says no. You ask him if he’s has ever had anaphylaxis in the past. He replies no.

      You ask the patient if he has ever had ciprofloxacin in the past. He says, yes. Recently, he stepped on a nail and the doctor prescribed ciprofloxacin to treat the skin infection that resulted. That was about 1 month ago.

      Mystery: Then why would the doctor want ciprofloxacin listed as an allergy?

      Solution: Technically the patient is not allergic to ciprofloxacin

      because he did not develop a histamine mediated response to it. But the patient did have a severe adverse reaction after taking it, and the allergy feature in the computer system can prevent this from happening again.

      The FDA has assigned ciprofloxacin a black boxed warning that it could cause tendon ruptures1-2 and that is what happened to this young man. Just recently, the FDA added that ciprofloxacin can also cause aortic ruptures as well.3

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    • Posted

      Good post, Derek. We always advise people who have been affected by Ciprofloxacin or any of the other fluoroquinolones to say they are allergic to ALL fluoroquinolones. (The recent EMA review has accepted that the problems they cause are a "class effect" even if studies only mention one or two of them).

      The danger with the young man in your scenario is that he may be given Ofloxacin, say, or Levofloxacin or Moxifloxacin if his notes only name Ciprofloxacin. This has happened, of course!

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