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vol. 16
Clinical pharmacology
Letter to the Editor

Antioxidant therapy in the management of Fluoroquinolone - Associated Disability

Robert Pietruszyński
Agnieszka Pietruszyńska-Reszetarska
Jan Sokal
Marcin Domżalski

Cardiology Outpatient Clinic, Military Medical Academy Memorial Teaching Hospital of the Medical University of Lodz – Central Veterans’ Hospital, Lodz, Poland
Department of Internal Medicine and Cardiac Rehabilitation of the Medical University of Lodz, Lodz, Poland
Maria Konopnicka Paediatric Centre, Central Teaching Hospital of the Medical University, Lodz, Poland
Department of Orthopaedics and Traumatology, Medical University of Lodz, Lodz, Poland
Arch Med Sci 2020; 16 (6): 1483–1486
Online publish date: 2020/11/02
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Fluoroquinolone (FQ) antibiotics are often used in medical therapy, especially in the treatment of urinary tract infections (UTIs). Recently, serious adverse effects associated with their use have increasingly been reported. The US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database includes 210,705 adverse events (and 2,991 fatalities) related to the use of FQs, as of January 2016 [1]. The most common adverse drug reactions (ADRs) associated with the FQs involve the gastrointestinal tract (nausea and diarrhoea), the central and peripheral nervous system (headache, dizziness, a “pins and needles” tingling or pricking sensation, confusion, hallucinations, and suicidal thoughts). Other potentially serious events involve the cardiovascular system (QT interval prolongation), musculoskeletal system (arthropathy, tendinopathy, tendon rupture, muscle weakness, joint pain and swelling) and glucose homeostasis dysregulation [2].
The FDA first added a black-box warning label for FQs in July 2008 regarding the increased risk of tendinitis and tendon rupture. In August 2013, the agency required new updates to the labels to describe the potential for irreversible peripheral neuropathy. In 2016 the FDA strengthened these warnings and emphasised the association of FQs with disabling and potentially permanent serious side effects, the risks of which generally outweigh the benefits in treatments for acute bacterial sinusitis, chronic bronchitis and uncomplicated urinary tract infections. In their most recent update of July 2018, the FDA required the drug labels to state that FQs may cause significant decreases in blood sugar and certain mental health side effects.
FQs are widely used in clinical practice despite the FDA’s recommendations restricting the use of these antibiotics. Unfortunately, this means the number of patients suffering from serious and chronic side effects of FQs is still growing. In addition, there is a lack of causative treatment at the current time. Disease-modifying and symptomatic treatment is complex, difficult and not standardized.
We present the case of 43-year-old man, previously in good health, who experienced severe ADRs 5 days after completion of levofloxacin treatment, and was finally diagnosed with fluoroquinolone-associated disability (FQAD). In 2015, for urological reasons, the patient underwent empirical, prolonged antibiotic therapy including a 24-day course of...

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