E-drug: New article on ciprofloxacin side effects
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New article on ciprofloxacin side effects, released early and posted
on the internet full text free, about ciprofloxacin-induced peripheral
neuropathy. The Annals of Pharmacotherapy - forthcoming in the
December 2001 Volume 35: Number 12
Suppose that it can be interesting for E-druggers.
Prof. Vladimir S. Shoukhov, M.D., D.Sci (Med)
Tel./Fax: +7 (095) 9304105
E-mail: shoukhov@yahoo.com=20
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PERIPHERAL NEUROPATHY ASSOCIATED WITH CIPRO
CINCINNATI, OH - Adverse effects associated with the use of
ciprofloxacin (Cipro) and other fluoroquinolone antibiotics are not
always benign. Not infrequently, they can be severe and
permanently disabling, and they may occur following just one or a
few doses, according to a study posted on The Annals of
Pharmacotherapy Web site today. Scheduled for publication in
December 2001, this article is being made available now on the
Internet because of the threat of anthrax and subsequent
heightened interest in Cipro.
Jay S Cohen, MD, an Associate Professor of Family and Preventive
Medicine at the University of California, San Diego, and an expert
on adverse medication reactions, analyzed 45 cases in which
fluoroquinolone antibiotics (including 11 involving ciprofloxacin)
were associated with adverse effects involving the peripheral
nervous system such as tingling, numbness, burning pain, twitching,
or spasms. Moreover, 42 (93%) of these patients also sustained
adverse effects involving other systems. Seventy-eight percent
experienced central nervous system (CNS) symptoms such as
dizziness, agitation, impaired cognitive function, or hallucinations,
and 73% reported musculoskeletal symptoms such as joint or
muscle pain or tendon rupture. Adverse events also involved the
cardiovascular and gastrointestinal systems, skin, and special
senses in 18 (42%) of cases.
Assessments of severity revealed 2 cases that were mild (4%), 7
moderate (16%), and 36 severe (80%) with chronic pain and/or
significantly limited normal function. Symptoms were typically long-
term with 91% exceeding 1 month in duration, 71% exceeding 3
months, and 58% exceeding 1 year. Twelve cases (27%) lasted
longer than 2 years. These severe, long-term reactions occurred in
a generally young and healthy population. The average patient age
was 42 (range 11=AD68). Sixty-two percent had no other medical
disorder except the infection (mainly sinusitis, prostatitis, urinary
infections) that prompted fluoroquinolone therapy.
Onset of adverse events was usually rapid, with 15 cases (33%)
beginning within 24 hours of starting fluoroquinolone treatment, 26
(58%) beginning within 72 hours, 38 (84%) occurring within 7 days,
and 43 (96%) within 14 days. While some patients reported that
their physicians acted promptly to discontinue the antibiotics when
symptoms occurred, 18 patients stated that their physicians either
failed to recognize or dismissed the significance of their
neuropathies or more commonly recognized events such as joint
pain, tendon pain, or CNS symptoms. At least 4 patients reported
being told to continue taking the antibiotics despite complaining of
adverse events. Fourteen patients received more than one course
of fluoroquinolone treatment; in each case, adverse events had
occurred with the initial prescription. Apparently, these physicians
did not know that fluoroquinolone toxicities may be cumulative.
Because of the current anthrax threat and the hoarding of
ciprofloxacin by thousands of people, it is imperative that physicians
and the public understand the benefits and potential risks of using
ciprofloxacin or other fluoroquinolone antibiotics indiscriminately.
The media have, generally, presented only a few fluoroquinolone
adverse effects, which are usually described as mild and brief.
There are anecdotal reports of people already taking ciprofloxacin
prophylactically. The cases presented in this article, as well as
previously published articles about the adverse effects of
fluoroquinolones, should give patients and physicians pause before
using fluoroquinolones unnecessarily, especially because other,
safer antibiotics (penicillin, doxycycline) can often be used instead.
Moreover, people need to know that not all serious reactions
associated with fluoroquinolones are listed in package inserts or the
Physicians' Desk Reference. People must be informed that with the
development of any musculoskeletal, or peripheral or central
nervous system symptoms, fluoroquinolone treatment should be
discontinued immediately unless medical circumstances (e.g.,
severe infection and no alternative treatment) warrant otherwise.
Patients sustaining these reactions should not receive
fluoroquinolone antibiotics in the future.
The Annals of Pharmacotherapy is the leading international journal
featuring articles directly related to pharmacotherapy, the area of
pharmacy practice that promotes the safe, effective, and
economical use of drugs in patients. Some other recent articles that
have appeared in The Annals of Pharmacotherapy covering
quinolones, and ciprofloxacin in particular, include:
1. Paladino JA. Is more than one quinolone needed in clinical
practice? Ann Pharmacother 2001 Sep;35(9):1085-95.
2. MacCara ME, Sketris IS, Comeau DG, Weerasinghe SD. Impact
of a limited fluoroquinolone reimbursement policy on antimicrobial
prescription claims. Ann Pharmacother 2001 Jul-Aug;35(7-8):852-8.
3. Alghasham AA, Nahata MC. Clinical use of fluoroquinolones in
children. Ann Pharmacother 2000 Mar;34(3):347-59.
4. Alghasham AA, Nahata MC. Clinical use of fluoroquinolones in
children. Ann Pharmacother 2000 Mar;34(3):347-59.
5. Temple ME, Nahata MC. Interaction between ciprofloxacin and
rifampin. Ann Pharmacother 1999 Jul-Aug;33(7-8):868-70.
6. Otero MJ,Moran D, Valverde MP. Interaction between phenytoin and
ciprofloxacin. Ann Pharmacother 1999 Feb;33(2):251-2.
(Website - http://www.theannals.com.
Click the News Release on Cipro Neuropathy button to access the article.)
[Thanks for sharing this with us. There is an old adage that says 'Only
take the drug if the alternative is worse!' TD]
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