R&B singer Bobby Caldwell passed away this week Reportedly, after experiencing several years of health problems related to taking fluoroquinolone antibiotics, he took what he called “phlox.”
legendary musician who sangwhat you don’t do for love,” died at the age of 71.
He was not an isolated case. The FDA calls the constellation of rare symptoms some people experience: Fluoroquinolone-related disorder or FQAD Posted with boxed warning on the label. Several newer fluoroquinolones have been withdrawn from the market due to toxic effects.
All drugs have potential side effects, but these appear to vary in their variety and severity. A case of swelling of the tendon with ulceration was included. headaches and rashes; potentially life-threatening aortic aneurysms; neuropathy, a type of nerve damage. hyperglycemia; and anxiety.
Caldwell’s symptoms are reportedly nerve-related, torn Achilles tendon After being prescribed the drug in 2017.
What are Fluoroquinolones?
Fluoroquinolones refer to a class of antibiotics that includes ciprofloxacin (Cipro), levofloxacin (Levaquin), and moxifloxacin (Avelox). They are one of the most widely prescribed antibiotics in the United States. According to William L. Music, a pharmacist and infectious disease clinical expert at Houston Methodist Hospital, they are used to treat sinusitis, bronchitis, urinary tract infections, pneumonia, and gastrointestinal infections such as gastritis and diverticulitis. is frequently used in the treatment of
The drug is often life-saving and, unlike many other antibiotics, is easy to use in and out of the hospital.
“Very ill patients in hospitals can use oral formulations in the open as well as intravenous formulations,” said Musick. “This has made it very easy to treat someone aggressively in the hospital and give them a pill to take at home to finish the course. Unfortunately, there aren’t many antibiotics that meet that criteria. .”
They are also effective. “They’re great antibiotics. They can eradicate many infections, even anthrax, and they’re very cheap to make,” said Cecilia Bove, assistant professor of biology at York University in Pennsylvania. . Bobe studies, Posted in subject.
What does “phlox” mean?
Once the drug hit the market and was used by millions as opposed to being used in clinical trials by millions, some rare side effects inevitably appeared. It took a while, as the first label change (related to Achilles tendon rupture risk) wasn’t made until 2004, nearly 30 years after the drug was introduced.
While most drugs follow a similar cycle (the analgesics Vioxx and Celebrex are prime examples), fluoroquinolones seem to differ in many of the rare problems associated with them.
There are not only musculoskeletal problems like tendon rupture, but also psychiatric effects, aortic aneurysms, nerve problems, blood sugar problems, and digestive problems, collectively more like a syndrome than individual side effects. said Mr Bove.
Another difference is that many of the side effects are long lasting. Some are even permanent. “Researchers have noticed a group of patients who suffer for at least two to three months from a series of side effects that persist even after they stop using the drug,” he said.
“Unless it’s an event like a heart attack that can have long-term consequences, doctors often say that not only can side effects last longer than the duration of the drug, but new problems may arise after stopping the drug.” Beatrice Golomb, professor of medicine at the University of California, San Diego, said, “For example, someone started with a torn tendon, developed fatigue after using FQ, and developed neuropsychiatric symptoms.” There is likely to be.
What are the symptoms?
There is still a lot we don’t know about why fluoroquinolones have these effects in some people.
At a basic level, it’s clear that antibiotics aren’t just depleting bacteria, they’re also attacking the human body, Bove said. , which would explain the effect on the tendons, she added.
Her research team and others are trying to find common denominators that explain the effects on different physiological systems.
“It’s been an under-researched area because not many people have it,” Bove said. There is a possibility that
Fluoroquinolone-related disorders
In attempting to characterize FQAD, FDA states that the effects must disrupt a person’s ability to perform tasks of daily living and must persist for at least 30 days after stopping use of the drug. I’m here. Also, there must be symptoms in at least two of these body systems.
- musculoskeletal
- neuropsychiatry
- peripheral nervous system
- senses (visual, auditory, etc.)
- skin
- cardiovascular
WHO IS AT RISK?
It’s not entirely clear who is at risk of developing these symptoms.The FDA’s adverse event reporting system for cases from 1997 to 2015 found that about three-quarters of the cases were in people between the ages of 30 and 59. indicates that it occurs mostly in women.
one Nearly 50 million antibiotic prescriptions studied A troublesome increase in aortic aneurysms was noted within 90 days of using a fluoroquinolone (as opposed to another antibiotic) in adults in the United States, but only if the affected person was 35 years old. There appeared to be no pattern in age, gender, and underlying health, except for being older. (This study found an association, but could not prove that the fluoroquinolone was the direct cause.)
Aortic aneurysms occur when the inner layer of the largest blood vessel in the body separates from the outer layer, fills with blood, and bulges in a way that increases the risk of a dramatic and life-threatening rupture.
abuse of Fluoroquinolone
Like many antibiotics, fluoroquinolones appear to be overprescribed.
A CDC-conducted study published in 2018 found that 5.1% of adult outpatient fluoroquinolone prescriptions are for conditions that do not require antibiotics at all, and nearly 20% for conditions that should be treated with another antibiotic. Met.
“They are very easy and convenient to use in both inpatient and outpatient settings,” says Musick. “I feel strongly that it has led to outpatient abuse. Other options have been pushed aside.”
“Most people who develop these serious problems experienced at least mild side effects during or shortly after using FQ. There is no We report on four previously healthy adults who experienced these adverse effects“It’s often young, active people who don’t have chronic health problems, and often people who shouldn’t have taken antibiotics in the first place.”
what to do
Future efforts to reduce the incidence of these effects will probably be more about prevention than treatment. Musick said it could help sick patients.
“The label clearly states that these drugs should not be given for simple infections that can be treated with other antibiotics,” Bove said. I prescribe it for something as simple as a disease.”
“Many infections have multiple options for treatment, and the first question in the world of antibiotic management is, ‘Do I really need the antibiotics the patient has? Music said.
