Infectious Diseases: Safety Concerns with Fluoroquinolones

@article{Mehlhorn2007InfectiousDS,
  title={Infectious Diseases: Safety Concerns with Fluoroquinolones},
  author={Allana J. Mehlhorn and Dana A. Brown},
  journal={Annals of Pharmacotherapy},
  year={2007},
  volume={41},
  pages={1859 - 1866}
}
Objective: To review the chemistry, pharmacology, and safety of fluoroquinolones. Data Sources: A MEDLINE search (1966–July 2007) was conducted using the key words fluoroquinolones or quinolones with safety, adverse effects, hypoglycemia. hyperglycemia, dysglycemia. QTc prolongation, torsades, seizures, phototoxicity, tendon rupture, Clostridium difficile, and pseudomembranous colitis for articles published in the English language. Study Selection and Data Extraction: Medicinal chemistry, in… 
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TLDR
The data show that using moxifloxacin, in its accepted indications and following the corresponding guidelines, should not be associated with an excessive incidence of drug-related adverse reactions, provided the clinician takes care in identifying patients with known risk factors and pays due attention to the contraindications and warnings mentioned in the labelling.
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TLDR
Overall, it appears that levofloxacin is relatively well tolerated, with low rates of clinically important adverse events such as CNS toxicity, cardiovascular toxicity and dysglycaemia.
Safety Considerations of Fluoroquinolones in the Elderly
TLDR
Overall, the specific adverse-effect profile of quinolones must be considered when they are chosen for treatment of bacterial infections because of physiological changes in renal function and when certain co-morbidities are present, some special considerations are necessary when elderly patients are treated with these drugs.
Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review
TLDR
Clinicians should be cautious when prescribing macrolide and fluoroquinolone medications to patients with risk factors that may lead to antibiotic-induced cardiac arrhythmia, including a slow heart rate and those that are taking medications to treat arrhythmias.
Cardiovascular and metabolic safety profiles of the fluoroquinolones
TLDR
A comparison among Cardiovascular and metabolic safety profiles of the fluoroquinolones might be particularly useful for the prescribers' decision-making process as well as to hypothesize future researcher purposes.
Safety Profile of the Fluoroquinolones
TLDR
Patients did not show any statistically significant differences between 2005 and 2006 in terms of sex, age and number of concurrent medications, and data suggest that different fluoroquinolones are characterized by different rates and types of ADRs.
Fluoroquinolones in Community-Acquired Pneumonia
TLDR
Fluoroquinolone monotherapy may be associated with shorter hospital length of stay compared with β-lactam plus macrolide combination therapy, particularly in severe pneumonia or with high-dose therapy, and may have a role in healthcare-associated pneumonia when administered in combination with other antipseudomonal and anti-methicillin-resistant Staphylococcus aureus therapies.
Miscellaneous antibacterial drugs
Delafloxacin: Place in Therapy and Review of Microbiologic, Clinical and Pharmacologic Properties
TLDR
Available data pertaining to delafloxacin’s biochemistry, pharmacokinetic/pharmacodynamics characteristics, in vitro activity and potential for resistance selection as well as current progress in clinical trials are reviewed to ultimately assist clinicians in selecting patients who will benefit most from the distinctive properties of this agent.
Prulifloxacin: clinical studies of a broad-spectrum quinolone agent.
TLDR
Prulifloxacin has an acceptable toxicity profile, comparable to that of other fluoroquinolones, with gastric disturbances, diarrhea, nausea and skin rash of mild-to-moderate severity being the most frequent adverse events.
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References

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  • R. Owens, P. Ambrose
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2005
TLDR
The currently marketed quinolones are well tolerated, with safety profiles similar to those of other antimicrobial classes, although adverse effects are unusual, some, including tendinitis and CNS-related effects, are more common with quInolones than with other antimacterial classes.
History of Quinolones and Their Side Effects
TLDR
Levofloxacin had the lowest rate of CNS effects and skin adverse events among the agents listed, and the structure of the quinolones directly relates to both their activity and side-effect profiles.
Fluoroquinolone‐Associated Dysglycemias: A Tale of Two Toxicities
TLDR
This editorial elaborates on the tale of two toxicities, that is, hypoglycemia and hyperglycemia, and examines the impact of fluoroquinolones on perturbations in blood glucose concentrations.
Fluoroquinolone toxicity profiles: a review focusing on newer agents.
  • Benjamin A Lipsky, C. Baker
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    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1999
TLDR
Fluoroquinolones are safe in elderly, human immunodeficiency virus-infected, and neutropenic patients, but because of possible effects on articular cartilage, they are not currently recommended for children or pregnant women.
A Rare but Serious Side Effect of Levofloxacin
TLDR
An elderly patient with hypoglycemia associated with levofloxacine therapy who did use oral antidiabetic drugs or insulin is described, who was interned for urinary infection and pneumonia.
Comparative Tolerability of the Newer Fluoroquinolone Antibacterials
TLDR
Among the newer fluoroquinolones, clinically significant cardiac events are rare or absent but possible interactions in patients receiving other drugs capable of causing QT prolongation should be anticipated.
Moxifloxacin prophylaxis in neutropenic patients.
TLDR
During moxifloxacin prophylaxis, a significantly increased incidence of Gram-negative bacteraemia and CDAD is observed and caution is warranted when applying fluoroquinolones with high anaerobic activity in the neutropenic setting.
Fatal Hypoglycemia Associated with Levofloxacin
TLDR
A case of fatal hypoglycemia related to levofloxacin administration in an elderly patient with diabetes is reported, suggesting that patients with diabetes should be cognizant of this potential adverse effect in patients with Diabetes.
Gatifloxacin and the elderly: pharmacokinetic-pharmacodynamic rationale for a potential age-related dose reduction.
TLDR
Gatifloxacin exposure in 10 patients with severe hyperglycaemia is examined to provide a pharmacokinetic-pharmacodynamic (PK-PD) rationale for a potential age-related dose reduction to avoid high exposures, and the likely impact of such a dose reduction on clinical efficacy is evaluated.
Seizures Associated with Fluoroquinolones
TLDR
Although levofloxacin monotherapy has not been implicated in inducing seizures, it appears to be the causative agent in the second case, and the quinolones may have been a necessary, but not sufficient, cause in a patient with electrolyte abnormalities.
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