The group of fluoroquinolones
with its most famous member ciprofloxacin is such a case: Fluoroquinolones
are some of the most frequently used broad-spectrum antibacterial antibiotics, and usually prescribed for respiratory, urinary or ear infections.
Among these, 2,350 (65%) were fluoroquinolone
nonsusceptible, 418 (12%) were MDR, and none had resistance to ceftriaxone.
have caused at least 67 cases of life-threatening hypoglycemic coma, including 13 deaths and 9 permanent and disabling injuries, according to an internal safety review by the Food and Drug Administration.
The patient Medication Guide that is required to be given to the patient with each fluoroquinolone
prescription describes the safety issues associated with these medicines.
The low blood glucose levels induced by fluoroquinolone
antibiotics can result in health problems, including coma, especially among older people and those with diabetes who are on medications to reduce blood glucose.
At our institution as well as other military and civilian medical centers, it is common to use the antipseudomonal beta lactam piperacillin-tazobactam in combination with a fluoroquinolone
for empiric gram-negative coverage.
Interestingly, the number of fluoroquinolone
prescriptions did not decrease after the box warning for tendonitis and tendon rupture in 2008, or following the special warning about peripheral neuropathy in 2013.
After conducting a safety review of the drugs, the FDA concluded that fluoroquinolone
should be reserved for those patients who do not have alternative treatment options, in light of the findings that the antibiotics--when used systemically in either tablet, capsule, or injectable form--are associated with "disabling and potentially permanent serious side effects" that can occur together.
To evaluate the feasibility of predicting resistance to fluoroquinolones
in GBS directly from short-read genome data, we first searched the literature for articles reporting mutations in genes parC, parE, gyrA, and gyrB that have been associated with fluoroquinolone
resistance and created a working database of known mutations conferring resistance to this antimicrobial class.
The results of DNA gyrase sensitivity testing of this mutant revealed that the development of fluoroquinolone
resistance is not the result of mutation in DNA gyrase.
Tolerability of Fluoroquinolone
Antibiotics: Past, Present and Future.
Third and fourth generation fluoroquinolone
antibacterials: a systematic review of safety and toxicity profiles.