The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today.

The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today.

http :// ilena-rosenthal.blogspot,com
Health Lover

Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
Propaganda false claim:

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~

He also hawks the now admittedly dangerous flu vaccinations ...

http :// groups.google,com /group/sci.med.nutrition/browse_thread/thread/c1e2396e813b6d69/e1a42f7671703084?lnk=st&q=author%3Askeptic+influenza+OR+flu#e1a42f7671703084
Sun, 14 Jan 2007 17:36:53 GMT

Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
claim:

Lots of things are not "needed". Getting the flu shot, however,
reduces the likelihood of getting the flu and if you do get it,
reduces it the severity and duration of symptoms. For a pretty benign
shot, the effects are overwhelmingly positive. Why take a chance of
getting the flu if you can avoid it? Seems like only an idiot would
do that. Are you an idiot? No need to answer.

~~~~~~~~~~~`

God help his patients who are faced with the cowardly pharma shill as
a medical doctor.

Read this information about FQ drugs that Fake Skeptic Stahl dismisses
with one grunt.

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~~~~~
http :// www .fqresearch.org/

The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
include:
Tendon and Muscle Pain Insomnia Burning Pain Digestion
Disorders Anxiety Heart Problems Vision Disorders Ringing
in the Ears Rashes Hyperglycemia Depersonalization Mental
Disorders Seizures PAIN Liver Failure Stroke Other Adverse
Reactions

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

What I said - I speak for myself only - is that cipro, when considering abx,
is a relatively safe one. All abx have side effects. Things like
resistance is something they all have to contend with. What you did was
simply give the laundry list of possible adverse events of cipro. For some
reason, you capped PAIN as one.

I'll indulge you - the medically clueless. Penicilling (PCN) analogues are
the most frequent class to have allergic reactions to. PCN can cause
anaphylaxis and death. I'd capitalize that long before "pain". I've been
prescribing abx for years. I've ONCE had to have a patient change from
cipro to another med because of side effects. In my field (Urology), we use
cipro more than many others. I have people on it for months at a time.
Months. No problems. I have had to change NUMEROUS other abx b/c of side
effects ranging from the concerning rash/hives to the less serious "I think
my stomach gets upset". Both my kids, it t

"Ilena Rose" <BIA@mundo,com > wrote in message
news:32ljr39jse89h4vdf8spbg6ri6m8aignoe@4ax,com ...
> http :// ilena-rosenthal.blogspot,com
> Health Lover
>
> Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
> Propaganda false claim:
>
> "They're actually one of the safe, more effective antibiotics
> available today."
>
> ~~~~~~~~~~~~~
>
> He also hawks the now admittedly dangerous flu vaccinations ...
>
> http :// groups.google,com /group/sci.med.nutrition/browse_thread/thread/c1e2396e813b6d69/e1a42f7671703084?lnk=st&q=author%3Askeptic+influenza+OR+flu#e1a42f7671703084
> Sun, 14 Jan 2007 17:36:53 GMT
>
> Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
> claim:
>
> Lots of things are not "needed". Getting the flu shot, however,
> reduces the likelihood of getting the flu and if you do get it,
> reduces it the severity and duration of symptoms. For a pretty benign
> shot, the effects are overwhelmingly positive. Why take a chance of
> getting the flu if you can avoid it? Seems like only an idiot would
> do that. Are you an idiot? No need to answer.
>
> ~~~~~~~~~~~`
>
> God help his patients who are faced with the cowardly pharma shill as
> a medical doctor.
>
> Read this information about FQ drugs that Fake Skeptic Stahl dismisses
> with one grunt.
>
> "They're actually one of the safe, more effective antibiotics
> available today."
>
> ~~~~~~~~~~~~~~~~~
> http :// www .fqresearch.org/
>
> The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
> include:
> Tendon and Muscle Pain Insomnia Burning Pain Digestion
> Disorders Anxiety Heart Problems Vision Disorders Ringing
> in the Ears Rashes Hyperglycemia Depersonalization Mental
> Disorders Seizures PAIN Liver Failure Stroke Other Adverse
> Reactions

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

Finishing my thought below... my computer bugged out on me...

... both my kids have had some sort of negative reaction to PCN based meds.
These things happen. You know what's worse than the potential problems with
cipro? An untreated infection! In my field, we see a lot of multi-drug
resistant pseudomonal infections (a type of bacteria). Cipro (the and other
quinolones) is often one that it is susceptible to. It's often the ONLY abx
that the patient doesn't need an IV for, something of HUGE significance when
considering cost, compliance, a drain on resources, and potentially saving
needed hospital beds for more ill patients.

See Ilena - these topics need to be better thought out. It's not always so
A is bad and B is good. I won't indulge your desire to get into vaccines
again. Been there done that. I get my flu shot annually. I think it's a
great idea for all people. The flu sucks. These possible long term side
effects are unproven and probably just silly. That said, even if real, I'll
take my chances because I don't want the flu again and in my line of work, I
can't afford to miss an unplanned week of work.

"Skeptic" <bcs002b@yahoo,com > wrote in message
news:Gonuj.39613$9j6.288@attbi_s22...
> What I said - I speak for myself only - is that cipro, when considering
> abx, is a relatively safe one. All abx have side effects. Things like
> resistance is something they all have to contend with. What you did was
> simply give the laundry list of possible adverse events of cipro. For
> some reason, you capped PAIN as one.
>
> I'll indulge you - the medically clueless. Penicilling (PCN) analogues
> are the most frequent class to have allergic reactions to. PCN can cause
> anaphylaxis and death. I'd capitalize that long before "pain". I've been
> prescribing abx for years. I've ONCE had to have a patient change from
> cipro to another med because of side effects. In my field (Urology), we
> use cipro more than many others. I have people on it for months at a
> time. Months. No problems. I have had to change NUMEROUS other abx b/c
> of side effects ranging from the concerning rash/hives to the less serious
> "I think my stomach gets upset". Both my kids, it t
>
> "Ilena Rose" <BIA@mundo,com > wrote in message
> news:32ljr39jse89h4vdf8spbg6ri6m8aignoe@4ax,com ...
>> http :// ilena-rosenthal.blogspot,com
>> Health Lover
>>
>> Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
>> Propaganda false claim:
>>
>> "They're actually one of the safe, more effective antibiotics
>> available today."
>>
>> ~~~~~~~~~~~~~
>>
>> He also hawks the now admittedly dangerous flu vaccinations ...
>>
>> http :// groups.google,com /group/sci.med.nutrition/browse_thread/thread/c1e2396e813b6d69/e1a42f7671703084?lnk=st&q=author%3Askeptic+influenza+OR+flu#e1a42f7671703084
>> Sun, 14 Jan 2007 17:36:53 GMT
>>
>> Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
>> claim:
>>
>> Lots of things are not "needed". Getting the flu shot, however,
>> reduces the likelihood of getting the flu and if you do get it,
>> reduces it the severity and duration of symptoms. For a pretty benign
>> shot, the effects are overwhelmingly positive. Why take a chance of
>> getting the flu if you can avoid it? Seems like only an idiot would
>> do that. Are you an idiot? No need to answer.
>>
>> ~~~~~~~~~~~`
>>
>> God help his patients who are faced with the cowardly pharma shill as
>> a medical doctor.
>>
>> Read this information about FQ drugs that Fake Skeptic Stahl dismisses
>> with one grunt.
>>
>> "They're actually one of the safe, more effective antibiotics
>> available today."
>>
>> ~~~~~~~~~~~~~~~~~
>> http :// www .fqresearch.org/
>>
>> The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
>> include:
>> Tendon and Muscle Pain Insomnia Burning Pain Digestion
>> Disorders Anxiety Heart Problems Vision Disorders Ringing
>> in the Ears Rashes Hyperglycemia Depersonalization Mental
>> Disorders Seizures PAIN Liver Failure Stroke Other Adverse
>> Reactions
>
>

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

"Jim Hoover, regional manager for state government affairs for the
Bayer Corporation for the five northwest states, discussed second and
third generation quinolones. Bayer makes Ciprofloxacin, which has
multiple generic equivalents coming out in June that will have very
attractive prices. Normally the quinolone class of drugs is used in
patients who have failed at least one prior therapy. The patients tend
to be fairly ill and require relatively acute care that often may be
the last step before they are admitted into the hospital. ...By the time
the physicians get to this classification, they tend to have a good
idea of what bacteria is involved, what antibiotic is the most potent
for the bacteria and which penetrates that particular body side the
best. ...These drugs are often the last step before admission into the
hospital..." Alaska Pharmacy and Therapeutics Committee March 19,
2004

According to the manufacturer these drugs are often the last step
before being put in intensive care. And if I understand you correctly
you have given these to your kids? Even that is contra indicated
within the package inserts and only approved in the pediatric
population for Anthrax and serious non responding UTIs.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today


"davidtfull" <davidtfull@aol,com > wrote in message
news:c0556ba4-ddde-4b7b-837c-b8278fd11528@m23g2000hsc.googlegroups,com ...
> "Jim Hoover, regional manager for state government affairs for the
> Bayer Corporation for the five northwest states, discussed second and
> third generation quinolones. Bayer makes Ciprofloxacin, which has
> multiple generic equivalents coming out in June that will have very
> attractive prices. Normally the quinolone class of drugs is used in
> patients who have failed at least one prior therapy. The patients tend
> to be fairly ill and require relatively acute care that often may be
> the last step before they are admitted into the hospital. ...By the time
> the physicians get to this classification, they tend to have a good
> idea of what bacteria is involved, what antibiotic is the most potent
> for the bacteria and which penetrates that particular body side the
> best. ...These drugs are often the last step before admission into the
> hospital..." Alaska Pharmacy and Therapeutics Committee March 19,
> 2004
>
> According to the manufacturer these drugs are often the last step
> before being put in intensive care. And if I understand you correctly
> you have given these to your kids?

I said nothing about children.

> Even that is contra indicated
> within the package inserts and only approved in the pediatric
> population for Anthrax and serious non responding UTIs.

Example - there 2 medications that reach excellent levels in prostatic
secretions. One is cipro. The other is a medication that far more people
have problems tolerating (Bactrim) due to the sulfa component/allergy to it,
upset stomach, etc. So yes, a quinolone is a first line agent. It has been
recommended by various expert committees as a first line agent for UTI's as
well due to the sensitivity profile of common UTI causing pathogens.

THanks for the link about the stones. Haven't read the article yet, but I
will.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

On Feb 18, 2:11 pm, "Skeptic" <bcs0...@yahoo,com > wrote:
> What I said - I speak for myself only - is that cipro, when considering abx,
> is a relatively safe one.  All abx have side effects.  Things like
> resistance is something they all have to contend with.  What you did  was
> simply give the laundry list of possible adverse events of cipro.  For some
> reason, you capped PAIN as one.
>
> I'll indulge you - the medically clueless.  Penicilling (PCN) analogues are
> the most frequent class to have allergic reactions to.  PCN can cause
> anaphylaxis and death.  I'd capitalize that long before "pain".  I've been
> prescribing abx for years.  I've ONCE had to have a patient change from
> cipro to another med because of side effects.  In my field (Urology), we use
> cipro more than many others.  I have people on it for months at a time.
> Months.  No problems.  I have had to change NUMEROUS other abx b/c of side
> effects ranging from the concerning rash/hives to the less serious "I think
> my stomach gets upset".  Both my kids, it t
>
> "Ilena Rose" <B...@mundo,com > wrote in message
>
> news:32ljr39jse89h4vdf8spbg6ri6m8aignoe@4ax,com ...
>
>
>
> > http :// ilena-rosenthal.blogspot,com
> > Health Lover
>
> > Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
> > Propaganda false claim:
>
> > "They're actually one of the safe, more effective antibiotics
> > available today."
>
> > ~~~~~~~~~~~~~
>
> > He also hawks the now admittedly dangerous flu vaccinations ...
>
> > http :// groups.google,com /group/sci.med.nutrition/browse thread/thread...
> > Sun, 14 Jan 2007 17:36:53 GMT
>
> > Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
> > claim:
>
> > Lots of things are not "needed".  Getting the flu shot, however,
> > reduces the likelihood of getting the flu and if you do get it,
> > reduces it the severity and duration of symptoms.  For a pretty benign
> > shot, the effects are overwhelmingly positive.  Why take a chance of
> > getting the flu if you can avoid it?  Seems like only an idiot would
> > do that.  Are you an idiot? No need to answer.
>
> > ~~~~~~~~~~~`
>
> > God help his patients who are faced with the cowardly pharma shill as
> > a medical doctor.
>
> > Read this information about FQ drugs that Fake Skeptic Stahl dismisses
> > with one grunt.
>
> > "They're actually one of the safe, more effective antibiotics
> > available today."
>
> > ~~~~~~~~~~~~~~~~~
> > http :// www .fqresearch.org/
>
> > The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
> > include:
> > Tendon and Muscle Pain      Insomnia      Burning Pain     Digestion
> > Disorders   Anxiety   Heart Problems    Vision Disorders     Ringing
> > in the Ears    Rashes   Hyperglycemia     Depersonalization Mental
> > Disorders    Seizures    PAIN  Liver Failure  Stroke   Other Adverse
> > Reactions- Hide quoted text -
>
> - Show quoted text -

I would have to respectfully disagree with these assertions. If you
had taken the time to even take a look at the website cited, www .fqresearch.org
you will find well over 4000 medical journal entries, clinical
studies, post marketing reports, etc. (all published in the leading
medical journals such as The New England Journal of Medicine, The
Southern Journal, The Annals of Pharmacology, as well as readily found
on PubMed), that clearly and irrevocably rejects such a position. It
is also to be noted that there are currently TWO petitions filed with
the FDA (Public Citizen as well as the Attorney General of the State
of Illinois) seeking not only "Black Box" warnings but also "Dear
Doctor Letters". In fact in January of 2008 suit was filed in Federal
Court seeking to compel the FDA, as required by law, to respond to
these petitions. On February 14, 2008 Bayer issued (In Europe) a
"Dear Doctor" letter concering Avelox in relation to SEVERE LIVER
DAMAGE AND SEVERE SKIN DAMAGE. More than 50% of these drugs have been
removed from clinical practice due to severe toxicity issues resulting
in numerous DEATHS. This hardly sounds to me like a "safe
antibiotic". To continue this argument you will also find that
Levaquin has by far the worse safety profile of all the quinolone
drugs. The NDA (New Drug Application) studies revealed an adr rate
greater than 40% (one or MORE adverse reactions) as well as numerous
fatalities. We find the same statistics for just about all the drugs
in this class.

Perhaps I am a bit bias in this presentation as well. You see it was
an urologist, who believed this same unsupported drug company
propaganda, that blinded and crippled me for life. That was eight
years ago. I was given floxin, cipro and finally levaquin for a
fricking KIDNEY STONE. And this "safe" combination damn near killed
me. Did my urologist even recognize that I was having serious and
severe adrs to these drugs? Nope. Just kept increasing the dose
until I ended up in ER.

Permanent diplopia, chronic tendonitis, cystic formations on the liver
and kidneys, swollen lymph nodes, severe rash, hair literally falling
out, digestive system shot, pancreatitis, severely increased white
cell count, tendons shrunk on the hands so bad I can hardly even bend
them anymore, chronic fatigue and constant never ending pain for the
past eight years. All from a "safe" antibiotic? Before you reject
this out of hand keep in mind that FOUR different doctors have already
CONFIRMED

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

(cont) that these drugs were responsible. My rhuematologist,
hematologist, orthopedic surgeon, as well as an opthoneurologist. For
the past eight years as a result of this careless scripting my health
has continued to decline on a daily basis. Prior to this I had
absolutely NO medical problems to speak of. I developed a kidney
stone as a result of a prior regime of cipro (yes this can indeed
cause kidney stones) to treat a mild case of epidemitis that could
have just as easily been treated with any number of much safer
antibiotics. Bitter? You betcha. But this does nothing to change
the true safety profile of this class. The NUMBER ONE complaint of
patients so affected is the FACT that their treating physician knows
nothing about these severe reactions and refuses to associate with the
use of these drugs. The ignorance found within the medical community
is appalling. No offense meant in the least but you appear to be one
such physcian that they are complaining about.

One does not have an Attorney General seeking Black Box warnings for
"safe" drugs. They do however have their use. That being a drug of
last resort when all else has failed the patient. They are NOT and
CANNOT be considered a first line agent for any disease state. On
medications,com , one of the most respected drug site to be found on
the Internet reveals over 1,700 post citing to severe adverse
reactions to levaquin alone. Of ALL the drugs found on that site,
whether a quinolone or otherwise, more adverse reactions have been
posted concerning levaquin. And this site list thousands of drugs.
More adverse reactions have been reported on that site for the
quinolone class than ALL the other drugs combined with the lone
exception being a birth control pill. These statistics are repeated
throughout the Internet. As well as to be found on MedMatch. I know
this for a fact as I had obtained this data under the freedom of
information act. (concerning medwatch) And less than 1-4% of such
reactions are ever reported to the FDA.

As such you are more than welcomed to continue to subject your
patients to this unacceptable risk and then bitch when they sue you
for malpractice. For using this class for anything less than a life
threatening situation has been found by the courts to be exactly that.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today


"davidtfull" <davidtfull@aol,com > wrote in message
news:fdab4f38-56ac-46bd-827b-45dd8ba3c37f@f47g2000hsd.googlegroups,com ...
> (cont) that these drugs were responsible. My rhuematologist,
> hematologist, orthopedic surgeon, as well as an opthoneurologist. For
> the past eight years as a result of this careless scripting my health
> has continued to decline on a daily basis. Prior to this I had
> absolutely NO medical problems to speak of. I developed a kidney
> stone as a result of a
> prior regime of cipro (yes this can indeed
> cause kidney stones)

Interesting - can you please cite me the reference that proved that cipro
use increases risk of stones over placebo? Thanks!

> to treat a mild case of epidemitis that could
> have just as easily been treated with any number of much safer
> antibiotics.

Such as? Cipro is a great drug to treat epididymitis (I'm assuming that is
what you meant). If left untreated or inadequately treated, you can end up
hospitalized with IV antibiotics.

> Bitter? You betcha. But this does nothing to change
> the true safety profile of this class. The NUMBER ONE complaint of
> patients so affected is the FACT that their treating physician knows
> nothing about these severe reactions and refuses to associate with the
> use of these drugs. The ignorance found within the medical community
> is appalling. No offense meant in the least but you appear to be one
> such physcian that they are complaining about.

Then provide some evidence.

> One does not have an Attorney General seeking Black Box warnings for
> "safe" drugs. They do however have their use. That being a drug of
> last resort when all else has failed the patient. They are NOT and
> CANNOT be considered a first line agent for any disease state.

Correction - they are. That's a medical fact my friend.

> On
> medications,com , one of the most respected drug site to be found on
> the Internet reveals over 1,700 post citing to severe adverse
> reactions to levaquin alone. Of ALL the drugs found on that site,
> whether a quinolone or otherwise, more adverse reactions have been
> posted concerning levaquin. And this site list thousands of drugs.
> More adverse reactions have been reported on that site for the
> quinolone class than ALL the other drugs combined with the lone
> exception being a birth control pill. These statistics are repeated
> throughout the Internet.

And if that is your basis your "facts" I now see why you're so off. You've
fallen into a self-fulfilling prophecy.

> As well as to be found on MedMatch. I know
> this for a fact as I had obtained this data under the freedom of
> information act. (concerning medwatch) And less than 1-4% of such
> reactions are ever reported to the FDA.

Things you read on the internet are not "fact". Many are comments from 12
years olds who's girlfriend hasn't logged on yet.

> As such you are more than welcomed to continue to subject your
> patients to this unacceptable risk and then bitch when they sue you
> for malpractice.

Can't sue for following the standard of care. And as I mentioned
previously, the quinolones is one of antibiotics I have the absolute fewest
complaints over. And believe me, we hear about it from patients when a
medication is causing some adverse reaction. But really, you have 12 year
olds to trust...

> For using this class for anything less than a life
> threatening situation has been found by the courts to be exactly that.

Um, no, it has not.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

Here is the source you requested regarding cipro causing stones:

BILATERAL HYDRONEPHROSIS FROM CIPROFLOXACIN INDUCED CRYSTALLURIA AND
STONE FORMATION
NAGESH CHOPRA*; PAUL L. FINE; BARBARA PRICE; IAN ATLAS
THE JOURNAL OF UROLOGY 2000;164:438
“Ciprofloxacin is a widely used fluoroquinolone for the treatment of
complicated and uncomplicated infections. Experimental studies in
humans and animals have indicated that crystalluria may be associated
with the administration of fluoroquinolones but, to our knowledge, no
case of obstructive uropathy has been reported. We describe a case of
bilateral urinary tract obstruction and acute renal failure due to
urinary tract stones predominantly composed of ciprofloxacin.” (which
by the way is EXACTLY what happened to me, other than the renal
failure part)

Also citing to:
Nakano M, Ishihara S, Deguchi T, Kuriyama M, Kawada Y.Fluoroquinolone
associated bladder stone.
J Urol. 1997 Mar;157(3):946. No abstract available.
PMID: 9072608 [PubMed - indexed for MEDLINE]

As well as:
Hammann C, Guelpa G.[Drug-induced calculi]
Schweiz Rundsch Med Prax. 1993 Oct 12;82(41):1129-32. French.
PMID: 8210886 [PubMed - indexed for MEDLINE]

Also I am certain that you treat hematuria as well, but never
considered cipro to be the cause:

Infection. 1985 Jul-Aug;13(4):177-8. Related Articles, Links
Ciprofloxacin-induced hematuria.
Garlando F, Tauber MG, Joos B, Oelz O, Luthy R.
We used ciprofloxacin, a quinolone-derivative, to treat a lung
infection due to Pseudomonas aeruginosa in an adult cystic fibrosis
patient. On three different occasions the use of ciprofloxacin was
associated with the development of an asymptomatic hematuria with red
blood cell casts. The mechanism responsible for this hematuria is
presently unknown, but clinicians should be aware of this potential
adverse effect of ciprofloxacin.
PMID: 2931381 [PubMed - indexed for MEDLINE]

Also citing to:
Deka PM, Rajeev TP.Unusual cause of hematuria.
Urol Int. 2001;66(1):41-2.
PMID: 11150952 [PubMed - indexed for MEDLINE]

And no doubt you use these drugs to treat prostatitis as well. And I
am sure that you have read Campbell's Urology where it is stated that
less than 5% of all cases of prostatitis is caused by a bacterial
infection. If you are prescribing this to everybody who has a case of
prostatitis then in 95% of these case there is NO logical reason to do
so. But never the less over five years ago they found it did not do a
damn thing:

Source:
Urology. 2003 Oct;62(4):614-7. Related Articles, Links

Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in
men: a randomized placebo-controlled multicenter trial.
Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J,
Steinhoff G, Brock G, Patrick AB, Flax S, Goldfarb B, Palmer BW, Zadra
J.
Department of Urology, Queen's University, Kingston General Hospital,
Kingston, Ontario, Canada.

“This pilot placebo-controlled study showed that 6 weeks of
levofloxacin therapy in men diagnosed with CP/CPPS resulted in symptom
improvement that was not significantly different from that with
placebo at end of treatment or follow-up.”

**********

And here is another you may have overlooked:
Subject: quinolone induced Fournier gangrene
http :// www .medscape,com /viewarticle/458852 3
(use caution here, very graphic photos of this injury)

************

Source:
Past Issue Vol. 11, No. 3 March 2005
Antimicrobial Drug Prescribing for Pneumonia in Ambulatory Care
Conan MacDougall,* B. Joseph Guglielmo,* Judy Maselli,† and Ralph
Gonzales†
*University of California School of Pharmacy, San Francisco,
California, USA; and †University of California Department of Medicine,
San Francisco, California

“Of note, fluoroquinolone use in the 18- to 44-year age group more
than doubled from 2000 to 2002 (14% to 30%).Among fluoroquinolones
prescribed over all years of the study, 74% were for levofloxacin; 51%
of levofloxacin prescriptions were considered inappropriate-These
findings suggest that those prescribing antimicrobial drugs may be
increasingly using fluoroquinolones as a "one-size-fits-all" regimen
without accounting for differences due to age and other risk factors…”
(50% of the time there was no need to prescribe this drug)

**************

Source:
ODS POSTMARKETING SAFETY REVIEW
Consult: One-Year Post Pediatric Exclusivity Postmarketing
Adverse Events Review
Drug: Ciprofloxacin
NDA: 19-537, 19-847, 19-857, 20-780, 21-473, 21-554

“Pediatric Exclusivity Approval Date: December 22, 2003
The AERS database was searched for reports of adverse events (serious
and non-serious)
occurring with the use of Cipro (ciprofloxacin hydrochloride) in
pediatric patients. Up to
the "data lock" date of January 31, 2005, AERS contained 10,354 cases
for ciprofloxacin
(raw counts, all ages, foreign and domestic, as well as those with no
information on age
and country of origin).
DDRE was asked to focus on the 1-year period following the approval of
pediatric
exclusivity, December 22, 2003, to December 22, 2004. We used an AERS
data lock
date of January 31, 2005, to allow time for reports received up to
December 22, 2004, to
be entered into AERS. During the first 13 months after pediatric
exclusivity was granted,
AERS received a total of 686 cases (raw counts, all ages, foreign and
domestic, as well as
those with no information on age and country of origin).
The cases described hematological events , joint/tendon events ,
allergic hypersensitivity
reactions , CNS/convulsions , and pseudomembranous colitis, and
worsening of underlying disease.
During the first 13 months of pediatric exclusivity there was one
death, two reports of
disability and four of hospitalization.”

***********************

Source: DTB Vol 42 No 8 August 2004
“August 2004, Moxifloxacin (Avelox) when prescribed for Community
Acquired Pneumonia, Chronic Bronchitis, Acute Bacterial Sinusitis
offers no compelling advantages over established treatment. Claims
that oral moxifloxacin provides "rapid relief from chest infections"
are unsubstantiated.”

***************

Source:
Fluoroquinolone Utilization in the Emergency Departments of Academic
Medical Centers
Prevalence of, and Risk Factors for, Inappropriate Use
Ebbing Lautenbach, MD, MPH; Lori A. Larosa, PharmD; Nishaminy
Kasbekar, PharmD; Helen P. Peng, PharmD; Richard J. Maniglia, MD;
Neil O. Fishman, MD
Arch Intern Med.2003;163:601-605

“Of 100 total patients, 81 received an FQ for an inappropriate
indication. Of the 19 patients who received an FQ for an appropriate
indication, only 1 received both the correct dose and duration of
therapy. ( 1% received the appropriate drug at the appropriate dose,
hence 99% of the prescriptions were in error)”

*************

Antibiotic treatment does not help sore throats. British Medical
Journal N0 7104 Volume 315, August 9, 1997

Antibiotics do not improve sinusitis symptoms, study shows. Lancet
March 8, 1997 / World Health Report, 1996 World Health Organization
Geneva Switzerland May 1996

**********

Antibiotic use in treating bronchitis is unnecessary and risky The
Journal of Family Practice 1997;44(3):261-265

Source:
Letter
Canadian Family Physician
K. Bassett B. Mintzes V. Musini T.L. Perry Jr M. Wong J.M. Wright

“Gatifloxacin and moxifloxacin have no proven clinical advantages over
other fluoroquinolones, macrolides, or amoxicillin”

************

Not trying to bust your balls in the least here. Just trying to
provide you with the true safety profile of these drugs. If you
choose to ignore this that’s find by me. These are your patients we
are talking about here, not mine.

As I said what you now do with this information does not concern me in
the least. But you cannot now continue to claim ignorance as you have
done so far in this discussion.

Additionally, for the record, I am recognized by the courts as a
Expert Witness concerning these adverse reactions.

I rather doubt that the courts would allow this if my expertise is
based upon the ramblings of a twelve year old and his girlfriend.

Insult me all you care to.

All I am trying to do here is to prevent us from ever meeting face to
face in a civil courtroom. I find it to be a rather unpleasant affair
for all concerned. Even me.
And I am quite sure you would as well. Additionally I do not
prostitute myself either like so many of your peers. I offer my
testimony in exchange for actual out of pocket expense, not my time,
which I give freely just as I have done here and I derive NO profit
whatsoever from testifying.

But perhaps you will take the following to heart:

As stated within the 62nd meeting of the Anti-Infective Drugs Advisory
Committee (1995) where it was so eloquently stated:

"…when we talk about the issue of arthropathy that potentially
includes a number of things, ranging from simple effusion, for
instance, of a knee joint, which might rapidly resolve after the
conclusion of therapy, to a more permanent disability. .." (sic)

"…in September of 1997 there is now a ciprofloxacin suspension which
is available, and although it continues to have the same warning
statements about arthropathy in juvenile animals and the potential
concern in pediatric populations, obviously, the issue of off label
use will extend over to pediatric populations in this
formulation…."(sic)

"…An important safety question is, what adverse events should be
monitored, and Doctor Goldberger alluded to this earlier. This is some
of the examples I present. One is permanent lameness, reversible
lameness, joint effusion, joint pain, and even latent articular
disease or damage that may occur months or years following drug
exposure, and there may be others…."(sic)

"…And, data submitted to the Agency, as well as data from the
scientific literature, indicate that these lesions don't appear to be
reversible…"(sic)

"…Doctor Stahlmann in Berlin is working on an idea that it may be an
effect between the endocrines, the magnesium and the matrix and the
quinolone. And that data is just coming out now. But as to the exact
mechanism, I think you're right. I don't think we have a handle, as
far as I know, on the exact mechanism. If there's anybody else that
does, I'd sure like to hear it…"(sic)

"… Relating your personal experience, I was wondering about the
potential for a delayed effect that in fact one might have a patient
who had some histologic changes that would not be manifest clinically
for many years. Is that a potential?" (sic)

"… I think it is a potential…"(sic)

"… In trying to assess toxicity with a very sensitive assay, obviously
you've got tissue that you can look at in your animal models. There is
some human data that were collected by Doctor Urs Schaad using MRI
scanning in children and I'm wondering if you can correlate some of
your histopathologic findings with MR in the animal model to give us
an idea of how sensitive it would be sort of as a follow-up to Doctor
Klein's question is the MR something that will be able to predict long-
term outcomes, even if there are no clinical symptoms during
therapy…."(sic)

"… That I don't know. I'll just be perfectly frank. I don't know. But
on the slides I've seen from the animals from the chronic study, the
repaired articular cartilage that is there is principally
fibrocartilage yet it will provide the same joint margin and it has a
calcified base and when we stain it with safrain O screen there's no
proteoglycans there so it's going to make it an extremely
chondromalaistic area and beyond the one year I can't tell you what
the results will be…"(sic)

"…Anyway, it was by a group in Vienna where they looked at the
articular cartilage of postmortem specimens of articular cartilage
from kids with cystic fibrosis that had been on quinolones for a
period of time and they found that there was damage in the
chondrocytes…."(sic)

"…There were no deaths reported in U.S. pediatric zero to 18 year old
cases where a flouroquinolone was reported as the suspect drug.
However, there are eight deaths in the whole cohort of suspect and
concomitant flouroquinolone drug reports in the system. Five of these
deaths reported ciprofloxacin as a concomitant drug and not the
suspect drug. These five were U.S. cases with ages ranging from seven
months to six years. The remaining three deaths were all foreign, all
18 year old patients with either ofloxacin or norfloxacin reported as
the suspect drug…."(sic)

"…There are 14 reports of arthropathy or arthralgia in the pediatric
zero to 18 year old flouroquinolone reports. One report of a 14 year
old girl had both ofloxacin and lomefloxacin as the suspect drug so
there is an extra count because of the two flouroquinolones on this
one report. This particular report indicates that a pediatric
orthopedic surgeon diagnosed femoral anteversion as the cause for the
girl's arthralgia, therefore you see it listed twice, and not the
flouroquinolones. Most of the reports indicated that either an
involved knee or elbow with or without other joints was
involved…."(sic)

"…One interesting case which is not included on this slide for
arthralgias was a 15 year old boy who received ofloxacin IV for an
emergency appendectomy and had not grown more than his 70 inches in
height over the last year. The 15th percentile for height for a 15
year old boy however is 66.5 inches and the expected growth rate is
about two inches per year…"(sic)

"…Three patients had their seizure after the first dose of
flouroquinolone, one on ciprofloxacin and the other two on ofloxacin,
one of which had received ofloxacin several months earlier…"(sic)

"…The 15 psychiatric reports are a loose grouping of reports which
include events ranging from euphoria to psychosis. The ages range from
five to 18 years with the median at 15 years. There were two suicide
attempts, one on ofloxacin and the other on norfloxacin, three reports
of hallucination, one each on ciprofloxacin, ofloxacin and
norfloxacin, and one report of aggressive behavior with confusion in a
patient who had a psychiatric history and was on norfloxacin. The
seven cases of photosensitivity were reported with lomefloxacin with
one case on ciprofloxacin and two cases on ofloxacin. …"(sic)

"…I will mention that there were 152 U.S. cases aged zero to 18 years
in the U.S. AERS system suspect flouroquinolones in the WHO line
listing. The country with the most pediatric reports in the WHO
foreign reports is the United Kingdom with 177 reports followed by
Germany with 72 and France with 71. The rest of the countries had 20
or fewer reports…."(sic)

"…And with regards to muscular-skeletal events, 21 percent of the
patients had an event in ciprofloxacin…"(sic)

"…We have focused our analysis on joint disorders and pefloxacin. 79
cases were reported and consist mainly of arthralgia. I don't know the
pronunciation of hydrarthrosis -- 49 persons. It involved the knee in
52 cases, the wrist in 20 cases, the elbow in 20 cases, the shoulder
in 6 cases, the ankle in 5 cases, and the hip once. It is associated
with a functional discomfort in all cases, and when the duration of
this discomfort is known, it can persist more than one month in 61
percent of these cases. But the outcome was favorable in 58 cases
without discontinuation in two cases. …"(sic)

"…There have been sequelae in three cases with knee effusions
persisting one year later in one case with discomfort following 8
months later in the second case. The third case is articular. It is a
17-year-old patient who experienced arthropathy and the drug was not
suspected and the treatment was continued two followi

-- deleted messages --

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today


"davidtfull" <davidtfull@aol,com > wrote in message
news:7969a422-8b59-48d6-8072-78b0f4f3286e@q78g2000hsh.googlegroups,com ...

> > to treat a mild case of epidemitis that could
> > have just as easily been treated with any number of much safer
> > antibiotics.
>
> Such as? Cipro is a great drug to treat epididymitis (I'm assuming that is
> what you meant). If left untreated or inadequately treated, you can end up
> hospitalized with IV antibiotics.
>

Such as the following:

Epididymitis

Treatment: Drugs of choice in preferred order are:

1. Ceftriaxone

2. Vibramycin twice a day for 10 days in addition to the shot of
Ceftriaxone

3. Floxin is listed as an alternative treatment, not a first line
agent

4. Cipro in men older than 35 years or those who participate in anal
intercourse

5. Bactrim DS


*** REPLY ***
I suppose I should have clarified. Most epididymitis occurs in older men.
In younger men, we think of entirely different organisms and while cipro can
still be used, there are usually others to try first. For the majority,
however, cipro is the first line agent. Your comment above about anal
intercourse is laughable.


> Then provide some evidence.
did that already for you

No, you really didn't. You correctly pointed out that for younger patients
(the minority) cipro is not first line. But for most older patients, it is.
Bactrim is a great alternative especially if they
dont' have a sufla allergy.





They are NOT and CANNOT be considered a first line agent for any
disease state.

**REPLY:
But they are. It's a fact.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today


"davidtfull" <davidtfull@aol,com > wrote in message
news:c29c81ce-4ef5-4173-8ae0-b1d7582463c1@p43g2000hsc.googlegroups,com ...
On Feb 18, 2:11 pm, "Skeptic" <bcs0...@yahoo,com > wrote:
> What I said - I speak for myself only - is that cipro, when considering
> abx,
> is a relatively safe one. All abx have side effects. Things like
> resistance is something they all have to contend with. What you did was
> simply give the laundry list of possible adverse events of cipro. For some
> reason, you capped PAIN as one.
>
> I'll indulge you - the medically clueless. Penicilling (PCN) analogues are
> the most frequent class to have allergic reactions to. PCN can cause
> anaphylaxis and death. I'd capitalize that long before "pain". I've been
> prescribing abx for years. I've ONCE had to have a patient change from
> cipro to another med because of side effects. In my field (Urology), we
> use
> cipro more than many others. I have people on it for months at a time.
> Months. No problems. I have had to change NUMEROUS other abx b/c of side
> effects ranging from the concerning rash/hives to the less serious "I
> think
> my stomach gets upset". Both my kids, it t
>
> "Ilena Rose" <B...@mundo,com > wrote in message
>
> news:32ljr39jse89h4vdf8spbg6ri6m8aignoe@4ax,com ...
>
>
>
> > http :// ilena-rosenthal.blogspot,com
> > Health Lover
>
> > Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
> > Propaganda false claim:
>
> > "They're actually one of the safe, more effective antibiotics
> > available today."
>
> > ~~~~~~~~~~~~~
>
> > He also hawks the now admittedly dangerous flu vaccinations ...
>
> > http :// groups.google,com /group/sci.med.nutrition/browse_thread/thread...
> > Sun, 14 Jan 2007 17:36:53 GMT
>
> > Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
> > claim:
>
> > Lots of things are not "needed". Getting the flu shot, however,
> > reduces the likelihood of getting the flu and if you do get it,
> > reduces it the severity and duration of symptoms. For a pretty benign
> > shot, the effects are overwhelmingly positive. Why take a chance of
> > getting the flu if you can avoid it? Seems like only an idiot would
> > do that. Are you an idiot? No need to answer.
>
> > ~~~~~~~~~~~`
>
> > God help his patients who are faced with the cowardly pharma shill as
> > a medical doctor.
>
> > Read this information about FQ drugs that Fake Skeptic Stahl dismisses
> > with one grunt.
>
> > "They're actually one of the safe, more effective antibiotics
> > available today."
>
> > ~~~~~~~~~~~~~~~~~
> > http :// www .fqresearch.org/
>
> > The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
> > include:
> > Tendon and Muscle Pain Insomnia Burning Pain Digestion
> > Disorders Anxiety Heart Problems Vision Disorders Ringing
> > in the Ears Rashes Hyperglycemia Depersonalization Mental
> > Disorders Seizures PAIN Liver Failure Stroke Other Adverse
> > Reactions- Hide quoted text -
>
> - Show quoted text -

I would have to respectfully disagree with these assertions. If you
had taken the time to even take a look at the website cited,
www .fqresearch.org
you will find well over 4000 medical journal entries, clinical
studies, post marketing reports, etc. (all published in the leading
medical journals such as The New England Journal of Medicine, The
Southern Journal, The Annals of Pharmacology, as well as readily found
on PubMed), that clearly and irrevocably rejects such a position.

REPLY:

Disagree away. Simple fact - if there were 4000 articles showing their
obious danger, no government agency in the country would allow their use, no
hospital would accept their being used, and no physician would recommend
them as treatment. Allow me to offer you a piece of advice - the
information that ILena offers is biased, junk science, and invariably not
data... just people's opinions. I am not denying there are not people out
there that think they are dangerous any more than you would deny there are
people who think aliens from other planets walk among us. Belief in
something doesn't make it true.

What I have done is read the actual published DATA articles on this that
have shown no obvious problems.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

TENDON DAMAGE

1972

Nalidixic Acid arthralgia
Bailey et al (CMA Journal 1972; 107 601-605)

1976

Jouirland JP Les ruptures tendineusues. Le tendon normal et
patholoqique
Seminar de Monte Carlo 13-14 February 1976

1983

Norfloxacin induced rheumatic disease
Bailey et al (NZ Med J 1983; 96; 590)

1985

100 reported tendinopathies 1985-1992 France
In France, between 1985 and 1992, 100 patients who were being managed
with fluoroquinolones had tendon disorders, which included thirty-one
ruptures (Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of
tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)
http :// www .studiomedico,it /allegati/achille.pdf

1987

Ciprofloxacin an update on clinical experience
Areieri et al (Am J of Med 1987 82 381-386)

93 ruptures, 103 tendinopathies, 20 tenasynovitis, 1987-1997
Source: http :// www .sma.org/smj1999/junesmj99/harrell.pdf

1988

McEwan SR, Davey PG. Ciprofloxacin and tenosynovitis. Lancet 1988; 2:
900.

Adverse effects of fluoroquinolones
Halkin et al (Rev Infect Dis 1988 10 258-261)

Ciprofloxacin and tenosynovitis
McEwan et al ( Lancet 1988 15 900)

Tendon disorders attributed to fluoroquinolones; a study on 42
spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care
and Research 45; 2001 pages

1989

Arthritis induced by norfloxacin
Jeandel et al (J Rheumatol 1989 16 560-561)

1990

Histologic and Histochemical Changes in Articular Cartilages of
Immature Beagle Dogs Dosed with Difloxacin, a Fluoroquinolone
J.E. Kurkhardt et al (Vet Pathol 27;162-170, 1990)

1991

Rheumatolgical side effects of quinolones
Ribard et al (Baillere's Clin Rheumatol 1991 5 175-191)

Perrot S, Ziza JM, De Bourran-Cauet G, Desplaces N, Lachand AT.
[A new complication related to quinolones: rupture of Achilles tendon]
Presse Med. 1991 Jul 6-13;20(26):1234. French. No abstract available.
PMID: 1831902 [PubMed - indexed for MEDLINE]

1992

Seven Achilles tendinitis including three complicated by rupture
during fluoroquinolone therapy
Ribard et al (J Rheumatol 1992; 19; 1479-1481)

704 achilles tendinitis, 38 ruptures 1992-1998 Netherlands
Fluoroquinolone use and the change in incidence of tendon rupture in
the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July
1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38
had Achilles tendon rupture
source: http :// bmj,com /cgi/content/full/324/7349/1306

100 reported tendinopathies 1985-1992 France
In France, between 1985 and 1992, 100 patients who were being managed
with fluoroquinolones had tendon disorders, which included thirty-one
ruptures (Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of
tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)
http :// www .studiomedico,it /allegati/achille.pdf

Ribard P, Audisio F, Kahn MF, De Bandt M, Jorgensen C, Hayem G, Meyer
O, Palazzo E.
Seven Achilles tendinitis including 3 complicated by rupture during
fluoroquinolone therapy.
J Rheumatol. 1992 Sep;19(9):1479-81.
PMID: 1433021 [PubMed - indexed for MEDLINE]

Perrot S, Kaplan G, Ziza JM.
[3 cases of Achilles tendinitis caused by pefloxacin, 2 of them with
tendon rupture]
Rev Rhum Mal Osteoartic. 1992 Feb;59(2):162. French. No abstract
available.
PMID: 1604233 [PubMed - indexed for MEDLINE]

Lee WT, Collins JF.
Ciprofloxacin associated bilateral achilles tendon rupture.
Aust N Z J Med. 1992 Oct;22(5):500. No abstract available.
PMID: 1445042 [PubMed - indexed for MEDLINE]

Blanche P, Sereni D, Sicard D, Christoforov B.
[Achilles tendinitis induced by pefloxacin. Apropos of 2 cases]
Ann Med Interne (Paris). 1992;143(5):348. French. No abstract
available.
PMID: 1482040 [PubMed - indexed for MEDLINE]

Olivieri I, Padula A, Lisanti ME, Braccini G.
Longstanding HLA-B27 associated Achilles tendinitis.
Ann Rheum Dis. 1992 Nov;51(11):1265. No abstract available.
PMID: 1466609 [PubMed - indexed for MEDLINE]

1993

Spontaneous bilateral rupture of the Achille's tendon in a renal
transplant recipient
Mainard et al (Nephron 1993;65- 491-492)

Boulay I, Farge D, Haddad A, Bourrier P, Chanu B, Rouffy J
[Tendinopathy caused by ciprofloxacin with possible partial rupture of
Achilles tendon]
Ann Med Interne (Paris). 1993;144(7):493-4. French. No abstract
available.
PMID: 8141519 [PubMed - indexed for MEDLINE]

1994

Royer RJ, Pierfitte C, Netter P.
Features of tendon disorders with fluoroquinolones.
Therapie. 1994 Jan-Feb;49(1):75-6. No abstract available.
PMID: 8091374 [PubMed - indexed for MEDLINE]

Armengol S, Moreno JA, Xirgu J, Torrabadella P, Tomas R.
[Ciprofloxacin as a cause of a behavior disorder in a patient admitted
into intensive care]
Enferm Infecc Microbiol Clin. 1994 May;12(5):271-2. Spanish. No
abstract available.
PMID: 8049295 [PubMed - indexed for MEDLINE]

Donck JB, Segaert MF, Vanrenterghem YF.
Fluoroquinolones and Achilles tendinopathy in renal transplant
recipients.
Transplantation. 1994 Sep 27;58(6):736-7. No abstract available.
PMID: 7940700 [PubMed - indexed for MEDLINE]

Onieal ME.
Achilles injuries.
J Am Acad Nurse Pract. 1994 Mar;6(3):125-6. No abstract available.
PMID: 8003362 [PubMed - indexed for MEDLINE]

Scioli MW.
Achilles tendinitis.
Orthop Clin North Am. 1994 Jan;25(1):177-82. Review.
PMID: 8290227 [PubMed - indexed for MEDLINE]

Hernandez MV, Peris P, Sierra J, Collado A, Munoz-Gomez J.
[Tendinitis due to fluoroquinolones. Description of 2 cases]
Med Clin (Barc). 1994 Sep 10;103(7):264-6. Review. Spanish.
PMID: 7934295 [PubMed - indexed for MEDLINE]

Achilles tenditinis and tendon rupture due to fluoroquinolone therapy
Huston et al (New England Journal of Medicene 1994 331 748)

Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of tendon
disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)

Dekens-Konter JA, Knol A, Olsson S, Meyboom RH, de Koning GH.
[Tendinitis of the Achilles tendon caused by pefloxacin and other
fluoroquinolone derivatives]
Ned Tijdschr Geneeskd. 1994 Mar 5;138(10):528-31. Dutch.
PMID: 8139714 [PubMed - indexed for MEDLINE]

Prantera C, Kohn A, Zannoni F, Spimpolo N, Bonfa M.
Metronidazole plus ciprofloxacin in the treatment of active,
refractory Crohn's disease: results of an open study.
J Clin Gastroenterol. 1994 Jul;19(1):79-80. No abstract available.
PMID: 7930441 [PubMed - indexed for MEDLINE]

Van Linthoudt D, D'Oro A, Ott H.
[What is your diagnosis? Bilateral Achilles tendinitis associated with
quinolone treatment]
Schweiz Rundsch Med Prax. 1994 Feb 22;83(8):201-2. German. No abstract
available.
PMID: 8134743 [PubMed - indexed for MEDLINE]

Kawada A, Hiruma M, Morimoto K, Ishibashi A, Banba H.
Fixed drug eruption induced by ciprofloxacin followed by ofloxacin.
Contact Dermatitis. 1994 Sep;31(3):182-3. No abstract available.
PMID: 7821014 [PubMed - indexed for MEDLINE]

Guharoy SR.
Serum sickness secondary to ciprofloxacin use.
Vet Hum Toxicol. 1994 Dec;36(6):540-1.
PMID: 7900274 [PubMed - indexed for MEDLINE]


1995

Szarfman A, Chen M, Blum MD. More on fluoroquinolone antibiotics and
tendon rupture. N Engl J Med 1995; 332: 193[Free Full Text].

Magnesium Deficiency Induces Joint Cartilage Lesions in Juvenile Rats
which are Identical to Quinolone Induced Arthropathy
Stahlmann et al (Antimicrobial Agents and Chemotherapy, Sept., 1995 pg
2013-2018)

Pierfitte C, Gillet P, Royer RJ
More on fluoroquinolone antibiotics and tendon rupture.
N Engl J Med. 1995 Jan 19;332(3):193. No abstract available.
PMID: 7800022 [PubMed - indexed for MEDLINE]

Szarfman A, Chen M, Blum MD.
More on fluoroquinolone antibiotics and tendon rupture.
N Engl J Med. 1995 Jan 19;332(3):193. No abstract available.
PMID: 7800023 [PubMed - indexed for MEDLINE]

Norfloxacin induced arthalgia
Terry et al ( J Rheumatol 1995 22 793-794)

Fluoroquinolone Induced Tenosynovitis of the Wrist mimicking de
Quervain's Disease
Gillet et al (British Journal of Rheumatology vol 34 no 6 pg 583-584,
Feb 1995)

Mirovsky Y, Pollack L, Arlazoroff A, Halperin N.
[Ciprofloxacin-associated bilateral acute achilles tendinitis]
Harefuah. 1995 Dec 1;129(11):470-2, 535. Hebrew.
PMID: 8846955 [PubMed - indexed for MEDLINE]

1996

McGarvey WC, Singh D, Trevino SG. Partial Achilles tendon ruptures
associated with fluoroquinolone antibiotics: a case report and
literature review. Foot Ankle Int 1996; 17: 496-498[ISI][Medline].

Pierfitte C, Royer RJ.
Tendon disorders with fluoroquinolones.
Therapie. 1996 Jul-Aug;51(4):419-20. No abstract available.
PMID: 8953821 [PubMed - indexed for MEDLINE]

Hugo-Persson M.
[Rupture of the Achilles tendon after ciproxine therapy]
Lakartidningen. 1996 Apr 17;93(16):1520. Swedish. No abstract
available.
PMID: 8667750 [PubMed - indexed for MEDLINE]

Therapie 1996; 51: 419-420 Tendon disorders with fluoroquinolones 421
cases have been collected by the Centre de Pharmacovigilance, 340 of
tendinitis and 81 cases of tendon rupture.

McGarvey WC, Singh D, Trevino SG.
Partial Achilles tendon ruptures associated with fluoroquinolone
antibiotics: a case report and literature review.
Foot Ankle Int. 1996 Aug;17(8):496-8. Review.
PMID: 8863030 [PubMed - indexed for MEDLINE]

Skovgaard D, Feldt-Rasmussen BF, Nimb L, Hede A, Kjaer M.
[Bilateral Achilles tendon rupture in individuals with renal
transplantation]
Ugeskr Laeger. 1996 Dec 30;159(1):57-8. Danish.
PMID: 9012076 [PubMed - indexed for MEDLINE]

Jagose JT, McGregor DR, Nind GR, Bailey RR.
Achilles tendon rupture due to ciprofloxacin.
N Z Med J. 1996 Dec 13;109(1035):471-2. No abstract available.
PMID: 9006634 [PubMed - indexed for MEDLINE]

Ottosson L.
[An unexpected verdict by the HSAN in a case of Achilles tendon
rupture]
Lakartidningen. 1996 Dec 18;93(51-52):4712, 4715. Swedish. No abstract
available.
PMID: 9011717 [PubMed - indexed for MEDLINE]

Castagnola C, Suhler A.
[Tendinopathy and fluoroquinolones]
Ann Urol (Paris). 1996;30(3):129-30. French.
PMID: 8766149 [PubMed - indexed for MEDLINE]

Foot Ankle Int. 1996 Aug;17(8):496-8.
Partial Achilles tendon ruptures associated with fluoroquinolone
antibiotics: a case report and literature review.

Fluoroquinolone induced arthralgia and Magnetic Resonance Imaging
Loeuille et al (The Journal of Rheumatology volume 23 no 7 , July
1996)

Fluoroquinolone Induced Tendinopathy; Report of Six Cases
Zabraniedkl et al (The Journal of Rhuematology 1996; 23; 3)

Quinolone induced cartilage lesions are not reversible in rats
Forster et al (Arch Toxicol (1996) 70; 474-481)

Maki T, Heinasmaki T, Riutta J, Tikkanen T, Laasonen L, Eklund K.
[Bilateral Achilles tendon rupture caused by oral fluoroquinolones]
Duodecim. 1996;112(19):1818-20. Finnish. No abstract available.
PMID: 10596182 [PubMed - indexed for MEDLINE

ENGLAND
130 reported tendon inflammation or rupture (England, France and
Belgium, 1996)
The group cited 130 reports of tendon inflammation or rupture in
people who used the prescription drug in England, France and Belgium.
The FDA has received at least 52 reports of patients in the U.S. who
have suffered tendon damage
(from public citizens 1996 petition)
Szarfman et al. recommended that the labeling on packaging for
fluoroquinolone be up-dated to include a warning about the possibility
of tendon rupture. In its recommendations on the use of
this class of antibiotics, the British National Formulary
suggested that "at the first sign of pain or inflammation, patients
should discontinue the treatment and rest the affected limb until the
tendon symptoms have resolved."
British National Formulary. No. 32, p. 259. London, British Medical
Association, Royal Pharmaceutical Society of Great Britain, 1996.
{Notice how this labeling change has not be altered since 1996 and
appears to have been copied word for word in every monograph.}

FRANCE
921 reported tendon disorders France
340 reported tendonitis, 81 tendon ruptures 1996, WHO
Adverse drug reactions with fluoroquinolones The French system of drug
surveillance has analyzed the reports of adverse drug reactions (ADRs)
to fluoroquinolones since they were launched. The frequency of
reactions ranges from 1/15000 to 1/208000 case per days of treatment.
Cutaneous disorders and tendon disorders dominate in France, whereas
cutaneous effects and neuropsychiatric disorders are predominant in
the UK; tendon disorders take up only the 5th position. Among the most
unexpected ADRs are the following: 1- Shock 2- Acure renal failure
Tendon ruptures represent 81 cases for 921 reports of tendon disorders
which are related in decreasing order to pefloxacin 1/23130 case per
days of treatment, ofloxin, norfloxacin and ciprofloxacin 1/779600
case per days of treatment. Age and corticosteroids increase the risk
of tendon rupture. Therapie 1996; 51; 419-420 Tendon disorders with
fluoroquinolones 421 cases have been collected by the Centre de
Pharmacovigilance: 340 of tendinitis and 81 of tendon rupture. These
cases were attributed to Peflacine, Oflocet, Noroxine, Ciflox.
Tendinitis was characterized by a bilateral malleolar oedema
associated with a sudden pain. Sometimes this oedema evoked phlebitis.
The tendon rupture was generally preceded by a tendinitis but in half
of the cases it occurred without warning.
Source: http :// www .who-umc.org/newsletter/newsltr97 1.html (sic)


1997

Australia. The Adverse Drug Reactions Advisory Committee first
reported tendinitis in association with fluoroquinolone antibiotics in
1997. The Committee has continued to monitor this adverse reaction,
and has now received 60 reports of tendinitis, tensosynovitis and/or
tendon rupture in association with these drugs. Ciprofloxacin was most
frequently cited (55 reports), as well as norfloxacin (4) and enoxacin
(1).
Forty-five reports described tendinitis alone, one report described
tensosynovitis, and 14 reports documented tendon tear or rupture.
Fifty-five of the 60 reports specified the Achilles tendon, including
20 which described bilateral Achilles tendon damage. All 14 reports of
tendon rupture involved the Achilles tendon. The 58 patients ranged in
age from 38 to 91 years (median: 69), with no significant difference
between those with tendinitis and those with tendon rupture.
The daily doses of ciprofloxacin ranged from 500 mg to 2250 mg, with
46% of patients taking 1500 mg and 46% of patients taking 1000 mg
daily. For those who developed tendon rupture, 57% were taking 1500 mg
daily. Time to onset varied from within 24 hours after the drug was
commenced to 3 months after starting, but the majority of cases of
tendinitis occurred within the first week. Time to rupture was longer
with a median time of 2-3 weeks. Known risk factors for these
reactions include old age, renal dysfunction and concomitant
corticosteroid therapy. In the cases reported to the ADRAC, 29 reports
documented concomitant corticosteroid use, and in 21 of the other 31
reports the patients were aged 69 years or older. In the reports of
tendon rupture, 12 of the 14 described either concomitant steroid use
(9) or old age (9).
Prescribers are reminded to be alert for this reaction and to withdraw
the fluoroquinolone immediately when symptoms of tendinitis appear in
order to reduce the risk of tendon rupture.
[See also Pharmaceuticals Newsletter Nos. 7&8, July&August 1997.]
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)
Australia

93 ruptures, 103 tendinopathies, 20 tenasynovitis, 1987-1997
Source: http :// www .sma.org/smj1999/junesmj99/harrell.pdf


Poon CC, Sundaram NA.
Spontaneous bilateral Achilles

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

2000

Fluoroquinolone induced tendinopathy; also occurring with levofloxacin
Fleisch et al (Infection 28 2000 no 4 pages 256-257)

Infection. 2000 Jul-Aug;28(4):256-7.
Fluoroquinolone-induced tendinopathy: also occurring with
levofloxacin.

Quinolone and Tendon Ruptures
Casperian et al (Southern Medical Journal May 2000 vol 93 no 5 pages
488-491)

Evaluation of toxicokinetic variables and arthropathic changes in
juvenile rabbits after oral administration of an ivestigational
fluoroquinolone, pd 117596
Johnson et al (AJVR vol 61 no 11, pages, 1396-1402, November 2000)

Rupture of the patellar ligament one month after treatment with
fluoroquinolone
Rev Chir Orthop Reparatrice Appar Mot. 2000 Sep;86(5):495-7.

FINLAND
42 reported tendinopathies 2000
Finland:
Register of adverse drug reactions in 2000

The majority of ADR reports received among antibacterials concerned
levofloxacin, which is a fluoroquinolone antibiotic. Fourteen of the
reports were on tendinitis or rupture of the Achilles tendon.
Tendinitis caused by fluoroquinolones was discussed in TABU for the
first time in 1996. Since then the ADR register has received a total
of 42 reports on tendinopathies caused by
fluoroquinolones, over a third of which were ruptures of the tendon.
The use of fluoroquinolones has in-creased by about 75% since 1996.
Levofloxacin is responsible for the major part of this increase. It
has been marketed in Finland since mid 1998.
source: www .nam.fi/uploads/english/Publications/Tabu/tabu22001 eng.pdf

Casado Burgos E, Vinas Ponce G, Lauzurica Valdemoros R, Olive Marques
A.
[Levofloxacin-induced tendinitis]
Med Clin (Barc). 2000 Mar 4;114(8):319. Spanish. No abstract
available.
PMID: 10774524 [PubMed - indexed for MEDLINE]

Casparian JM, Luchi M, Moffat RE, Hinthorn D.
Quinolones and tendon ruptures.
South Med J. 2000 May;93(5):488-91. Review.
PMID: 10832946 [PubMed - indexed for MEDLINE]

Gravlee JR, Hatch RL, Galea AM.
Achilles tendon rupture: a challenging diagnosis.
J Am Board Fam Pract. 2000 Sep-Oct;13(5):371-3. No abstract
available.
PMID: 11001009 [PubMed - indexed for MEDLINE]


2001

Rev Clin Esp. 2001 Sep;201(9):539-40.
Achilles pain and functional impotence in a patient with chronic
obstructive pulmonary disease with pneumonia. Tendon rupture caused by
levofloxacin

Pharm World Sci. 2001 Jun;23(3):89-92.
Fluoroquinolone use and the change in incidence of tendon ruptures in
the Netherlands.
van der Linden PD, Nab HW, Simonian S, Stricker BH, Leufkens HG,
Herings RM.

Mennecier D, Thiolet C, Bredin C, Potier V, Vergeau B, Farret O.
[Acute pancreatitis after treatment by levofloxacin and
methylprednisolone]
Gastroenterol Clin Biol. 2001 Oct;25(10):921-2. French. No abstract
available.
PMID: 11852403 [PubMed - indexed for MEDLINE]

Csizy M, Hintermann B.
[Rupture of the Achilles tendon after local steroid injection. Case
reports and consequences for treatment]
Swiss Surg. 2001;7(4):184-9. German.
PMID: 11515194 [PubMed - indexed for MEDLINE]

Adverse reactions to fluoroquinolones an overview on mechanistic
aspects
De Sarro et al (Current Medicinal Chemistry 2001, 8, 371-384)

Fluoroquinolone use and the change in incidence of tendon rupture in
the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)

Tendon disorders attributed to fluoroquinolones; a study on 42
spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care
and Research 45; 2001 pages 235-239)

1847 reported tendinopathies December 2001
Tabelle 7
Pharmacovigilance: Meldungen von Tendinopathien im Vergleich zu allen
gemeldeten unerwünschten Arzneimittelwirkungen (UAW), Stand 17.
Dezember 2001.

Meldungen Schweiz (IKS-Datenbank) Welt (WHO-Datenbank)
Tendinopathie alle UAW Tendinopathie alle UAW
Ciprofloxacin 8 (5%) 155 649(2,2%) 29 090
Fleroxacin 9 (1,2 %) 754
Norfloxacin 1 (1%) 91 163 (2,1%) 7536
Ofloxacin 2 (6%) 34 432 (1,8%) 23 990
Levofloxacin 32 (41%) 79 576 (7,8%) 7432
Moxifloxacin 18 (4,5 %) 4030
Source: http :// www .saez.ch/pdf/2003/2003-02/2003-02-694.PDF
http :// www .saez.ch/pdf/2003/2003-02/2003-02-694.PDF

U.S. ARMED FORCES
Spontaneous Ruptures of the Achilles Tendon, US Armed Forces,
1998-2001
Methods. The Defense Medical Surveillance System was searched to
identify all incident ambulatory visits of active duty servicemembers
with a primary diagnosis of non-traumatic rupture of the achilles
tendon (ICD-9- CM code 727.67) and other tendon ruptures (ICD-9- CM
codes 727.60-727.66, 727.68-727.69) between January 1998 and May 2001.
The most striking finding of this analysis is the sudden and
significant increase in rates of achilles tendon ruptures beginning in
calendar year 2000. The increase was manifested across all Services
and in most demographic subgroups (table 1). Rates
of non-traumatic ruptures of several other tendons also increased
during the period; and increases in ruptures of the rotator cuff were
comparable to those of the achilles tendon.
Source: http :// amsa.army.mil/1Msmr/2002/v08 n01.pdf

Nuno Mateo FJ, Noval Menendez J, Suarez M, Guinea O.
[Achilles pain and functional impotence in a patient with chronic
obstructive pulmonary disease with pneumonia. Tendon rupture caused by
levofloxacin]
Rev Clin Esp. 2001 Sep;201(9):539-40. Spanish. No abstract available.
PMID: 11692412 [PubMed - indexed for MEDLINE]

Malaguti M, Triolo L, Biagini M.
Ciprofloxacin-associated Achilles tendon rupture in a hemodialysis
patient.
J Nephrol. 2001 Sep-Oct;14(5):431-2. No abstract available.
PMID: 11730281 [PubMed - indexed for MEDLINE]

Butler MW, Griffin JF, Quinlan WR, McDonnell TJ.
Quinolone-associated tendonitis: a potential problem in COPD?
Ir J Med Sci. 2001 Jul-Sep;170(3):198-9.
PMID: 12120977 [PubMed - indexed for MEDLINE]

Bharani A, Kumar H.
Drug points: Diabetes inspidus induced by ofloxacin.
BMJ. 2001 Sep 8;323(7312):547. No abstract available.
PMID: 11546701 [PubMed - indexed for MEDLINE]

van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July
1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38
had Achilles tendon rupture
source: http :// bmj,com /cgi/content/full/324/7349/1306


2002

[No authors listed]
Side effects of levofloxacin.
Prescrire Int. 2002 Aug;11(60):116-7. No abstract available.
PMID: 12199267 [PubMed - indexed for MEDLINE]

Hatori M, Matsuda M, Kokubun S.
Ossification of Achilles tendon--report of three cases.
Arch Orthop Trauma Surg. 2002 Sep;122(7):414-7. Epub 2002 May 03.
PMID: 12228804 [PubMed - indexed for MEDLINE]

Pouzaud F, Rat P, Cambourieu C, Nourry H, Warnet JM.
[Tenotoxic potential of fluoroquinolones in the choice of surgical
antibiotic prophylaxis in ophthalmology]
J Fr Ophtalmol. 2002 Nov;25(9):921-6. French.
PMID: 12515937 [PubMed - indexed for MEDLINE]

Sobel E, Giorgini R, Hilfer J, Rostkowski T.
Ossification of a ruptured achilles tendon: a case report in a
diabetic patient.
J Foot Ankle Surg. 2002 Sep-Oct;41(5):330-4.
PMID: 12400718 [PubMed - indexed for MEDLINE]

wood ML, Schlessinger S.
Levaquin induced acute tubulointerstitial nephritis--two case reports.
J Miss State Med Assoc. 2002 Apr;43(4):116-7. No abstract available.
PMID: 11989200 [PubMed - indexed for MEDLINE]


Fluoroquinolones and risk of Achilles tendon disorders: case-control
study BMJ 2002;324:1306-1307 ( 1 June ) P D van der Linden, researcher
a, M C J M Sturkenboom, assistant professor a, R M C Herings,
associate professor b, H G M Leufkens, professor b, B H Ch Stricker,
professor a.
a Pharmaco-epidemiology Unit, Department of Epidemiology &
Biostatistics and Internal Medicine, Erasmus Medical Centre Rotterdam,
PO Box 1738, 3000 DR Rotterdam, Netherlands, b Department of Pharmaco-
epidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Utrecht, Netherlands

Pai VS, Patel N.
Atypical coronal or sagittal Z ruptures of the achilles tendon: a
report of four cases.
J Foot Ankle Surg. 2002 May-Jun;41(3):183-5.
PMID: 12075907 [PubMed - indexed for MEDLINE]

van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker
BH.
Fluoroquinolones and risk of Achilles tendon disorders: case-control
study.
BMJ. 2002 Jun 1;324(7349):1306-7. No abstract available.
PMID: 12039823 [PubMed - indexed for MEDLINE]

Med Clin (Barc). 2003 Jan 25;120(2):78-9.
Comment on: Med Clin (Barc). 2002 Jun 8;119(1):38-9.
Levofloxacin and bilateral spontaneous Achilles tendon rupture

4 cases of levaquin induced tendintis (orign spansih)
Mica magazine of Chile Issn0034-9887 versi printed
Rev. m. Chilev.130n.11Santiagonov.2002
Rev Méd Chile 2002; 130: 1277-1281
Associated aquiliana Tendinitis to the levofloxacino use:
communication of four cases
Claudius Hoops And, Claudius Flowers W, Sergio Mezzano A.
Levofloxacin associated Achilles

Pedros A, Emilio Gomez J, Angel Navarro L, Tomas A.
[Levofloxacin and acute confusional syndrome]
Med Clin (Barc). 2002 Jun 8;119(1):38-9. Spanish. No abstract
available.
PMID: 12062009 [PubMed - indexed for MEDLINE]


Roberts C, Deliss L.:
Acute rupture of tendo Achillis.
J Bone Joint Surg Br. 2002 May;84(4):620; author reply 620. No
abstract available.
PMID: 12043793 [PubMed - indexed for MEDLINE]

Paffey MD, Faraj AA.
Acute rupture of tendo Achillis.
J Bone Joint Surg Br. 2002 May;84(4):620-1; author reply 621. No
abstract available.
PMID: 12043792 [PubMed - indexed for MEDLINE]

Chhajed PN, Plit ML, Hopkins PM, Malouf MA, Glanville AR.
Achilles tendon disease in lung transplant recipients: association
with ciprofloxacin.
Eur Respir J. 2002 Mar;19(3):469-71.
PMID: 11936524 [PubMed - indexed for MEDLINE]

Greene BL.Physical therapist management of fluoroquinolone-induced
Achilles tendinopathy.
Phys Ther. 2002 Dec;82(12):1224-31.
PMID: 12444881 [PubMed - indexed for MEDLINE]

Breck RW.
"Ciprofloxacin: a warning for clinicians".
Conn Med. 2002 Oct;66(10):635. No abstract available.
PMID: 12448217 [PubMed - indexed for MEDLINE]


2003

Journal of Antimicrobial Chemotherapy (2003) 51, 747-748
DOI: 10.1093/jac/dkg081
Advance Access publication 28 January 2003
Correspondence
Spontaneous Achilles tendon rupture in patients
treated with levofloxacin
L. J. Haddow, M. Chandra Sekhar, V. Hajela and
G. Gopal Rao


Schwalm JD, Lee CH.
Acute hepatitis associated with oral levofloxacin therapy in a
hemodialysis patient.
CMAJ. 2003 Apr 1;168(7):847-8.
PMID: 12668542 [PubMed - indexed for MEDLINE]

Oh YR, Carr-Lopez SM, Probasco JM, Crawley PG.
Levofloxacin-induced autoimmune hemolytic anemia.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1010-3.
PMID: 12841809 [PubMed - indexed for MEDLINE]

Bardin L.
Comments on 'Achilles tendinopathy'.
Man Ther. 2003 Aug;8(3):189; author reply 190-1. No abstract
available.
PMID: 12909446 [PubMed - indexed for MEDLINE]


[No authors listed]
Tendon abnormalities and hypersensitivity of levofloxacin.
Prescrire Int. 2003 Feb;12(63):20. No abstract available.
PMID: 12602391 [PubMed - indexed for MEDLINE]

DY, Song JC, Wang CC.
Anaphylactoid reaction to ciprofloxacin.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1018-23.
PMID: 12841811 [PubMed - indexed for MEDLINE]

[No authors listed]
Fluoroquinolones in ambulatory ENT and respiratory tract infections:
rarely appropriate.
Prescrire Int. 2003 Feb;12(63):26-7.
PMID: 12602405 [PubMed - indexed for MEDLINE]


Khaliq Y, Zhanel GG.
Fluoroquinolone-associated tendinopathy: a critical review of the
literature.
Clin Infect Dis. 2003 Jun 1;36(11):1404-10. Epub 2003 May 20. Review.
PMID: 12766835 [PubMed - indexed for MEDLINE]

Prasad S, Lee A, Clarnette R, Faull R.
Spontaneous, bilateral patellar tendon rupture in a woman with
previous Achilles tendon rupture and systemic lupus erythematosus.
Rheumatology (Oxford). 2003 Jul;42(7):905-6. No abstract available.
PMID: 12826711 [PubMed - indexed for MEDLINE]

Gold L, Igra H.
Levofloxacin-induced tendon rupture: a case report and review of the
literature.
J Am Board Fam Pract. 2003 Sep-Oct;16(5):458-60. Review. No abstract
available.
PMID: 14645337 [PubMed - indexed for MEDLINE]

Schindler C, Pittrow D, Kirch W.
Reoccurrence of levofloxacin-induced tendinitis by
phenoxymethylpenicillin therapy after 6 months: a rare complication of
fluoroquinolone therapy?
Chemotherapy. 2003 May;49(1-2):90-1. No abstract available.
PMID: 12756981 [PubMed - indexed for MEDLINE]

de La Red G, Mejia JC, Cervera R, Llado A, Mensa J, Font J.
Bilateral Achilles tendinitis with spontaneous rupture induced by
levofloxacin in a patient with systemic sclerosis.
Clin Rheumatol. 2003 Oct;22(4-5):367-8. No abstract available.
PMID: 14579169 [PubMed - indexed for MEDLINE]

Tomas ME, Perez Carreras M, Morillasa JD, Castellano G, Solis JA.
[Rupture of the Achilles' tendon secondary to levofloxacin]
Gastroenterol Hepatol. 2003 Jan;26(1):53-4. Spanish. No abstract
available.
PMID: 12525331 [PubMed - indexed for MEDLINE]

Mathis AS, Chan V, Gryszkiewicz M, Adamson RT, Friedman GS.
Levofloxacin-associated Achilles tendon rupture.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1014-7.
PMID: 12841810 [PubMed - indexed for MEDLINE]

Aros C, Flores C, Mezzano S.[Achilles tendinitis associated to
levofloxacin: report of 4 cases]
Rev Med Chil. 2002 Nov;130(11):1277-81. Spanish.
PMID: 12587511 [PubMed - indexed for MEDLINE]

Shah P.[Do tendon lesions occur during quinolone administration?]
Dtsch Med Wochenschr. 2003 Oct 17;128(42):2214. German. No abstract
available.
PMID: 14562223 [PubMed - indexed for MEDLINE]

Melhus A, Apelqvist J, Larsson J, Eneroth M.
Levofloxacin-associated Achilles tendon rupture and tendinopathy.
Scand J Infect Dis. 2003;35(10):768-70.
PMID: 14606622 [PubMed - indexed for MEDLINE]

Cebrian P, Manjon P, Caba P.
Ultrasonography of non-traumatic rupture of the Achilles tendon
secondary to levofloxacin.
Foot Ankle Int. 2003 Feb;24(2):122-4.
PMID: 12627618 [PubMed - indexed for MEDLINE]

Bernacer L, Artigues A, Serrano A.
[Levofloxacin and bilateral spontaneous Achilles tendon rupture]
Med Clin (Barc). 2003 Jan 25;120(2):78-9. Spanish. No abstract
available.
PMID: 12570920 [PubMed - indexed for MEDLINE]

Haddow LJ, Chandra Sekhar M, Hajela V, Gopal Rao G.
Spontaneous Achilles tendon rupture in patients treated with
levofloxacin.
J Antimicrob Chemother. 2003 Mar;51(3):747-8. No abstract available.
PMID: 12615887 [PubMed - indexed for MEDLINE]

Othmani S, Battikh R, Ben Abdallah N.
[The myo-tendinopathy caused by levofloxacin]
Therapie. 2003 Sep-Oct;58(5):463-5. French. No abstract available.
PMID: 14682197 [PubMed - indexed for MEDLINE]

Gutierrez E, Morales E, Garcia Rubiales MA, Valentin MO.
[Levofloxacin and Achilles tendon involvement in hemodialysis
patients]
Nefrologia. 2003 Nov-Dec;23(6):558-9. Spanish. No abstract available.
PMID: 15002793 [PubMed - indexed for MEDLINE]

Spontaneous Achilles tendon rupture in patients treated with
levofloxacin
L. J. Haddow, M. Chandra Sekhar, V. Hajela and G. Gopal Rao*
Department of Microbiology, University Hospital Lewisham, Lewisham
High Street, London SE13 6LH, UK 2003 The British Society for
Antimicrobial Chemotherapy

Clinical Infectious Diseases 2003;36:1404-1410
2003 by the Infectious Diseases Society of America. All rights
reserved.
Fluoroquinolone-Associated Tendinopathy: A Critical Review of the
Literature
Yasmin Khaliq1 and George G. Zhanel2

J Am Podiatr Med Assoc. 2003 Jul-Aug;93(4):333-5.
Fluoroquinolone therapy and Achilles tendon rupture.
Vanek D, Saxena A, Boggs JM.

Clin Rheumatol. 2003 Dec;22(6):500-1. Epub 2003 Oct 18.

Re: The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today

Peripheral Neuropathy

Orofacial dyskinesia after ofloxacin treatment. Reversible orofacial
dyskinesia after ofloxacin treatment.
De Bleecker JL, Vervaet VL, De Sarro A.
Department of Neurology, Gent University Hospital, Ghent, Belgium.
ja.debleeker@ugent.be


Cipro Induced Psychosis
A case of ciprofloxacin-induced acute polymorphic psychosis with a
distinct deficit of the executive functions
Grimm, Dr. Oliver and Alm, Dr. Barbara (2005)

Prolonged Electroconvulsive Therapy Seizure in a Patient Taking
Ciprofloxacin. Journal of ECT. 21(1):43-44, March 2005.
Kisa, Cebrail MD; Yildirim, Sema G MD; Aydemir, Cigdem MD; Cebeci,
Sevsen MD; Goka, Erol MD
"...the extended seizure in this patient is thought to be related to
ciprofloxacin..."

Antimicrobial-induced mania (antibiomania): a review of spontaneous
reports. Abouesh A, Stone C, Hobbs WR.

Gatifloxacin Precipitation of Psychosis in Alzheimer Disease
Roy R. Reeves, D.O., Ph.D.

Delirium Associated With Gatifloxacin
C. Loraine Sumner, B.A., and Richard L. Elliott, M.D., Ph.D.,
F.A.P.A., Macon, Ga.

Ciprofloxacin-induced oral facial dyskinesia in a patient with normal
liver and renal function.
Hosp Med. 2000 Feb;61(2):142-3. Lee CH, Cheung RT, Chan TM.
Department of Medicine, University of Hong Kong, Queen Mary Hospital,
Hong Kong.
Toxicol Appl Pharmacol. 1991 Nov;111(2):255-62. Related Articles,
Links

Ciprofloxacin-induced chorea.
Azar S, Ramjiani A, Van Gerpen JA.
Mov Disord. 2005 Feb 28; [Epub ahead of print]
PMID: 15739219 [PubMed - as supplied by publisher]

Mechanisms of pefloxacin-induced pain.
Bull Exp Biol Med. 2004 Apr;137(4):336-8. Kukushkin ML, Igonkina SI,
Guskova TA. Laboratory of Pathophysiology of Pain, Institute of
General Pathology and Pathophysiology, Russian Academy of Medical
Sciences, Moscow.

Generalized seizure and toxic epidermal necrolysis following
levofloxacin exposure.
Christie MJ, Wong K, Ting RH, Tam PY, Sikaneta TG. University of
Toronto, Nephrology Associates, Scarborough, Ontario, Canada, and
Scarborough General Hospital, Scarborough.
[General pharmacology of T-3761, a new oral quinolone antibacterial
agent (2). Effect on the respiratory and cardiovascular systems,
autonomic nervous system and other functions]
[Article in Japanese] Furuhata K, Hiraiwa T, Terashima N, Arai H, Ono
S, Hashiba K, Maekawa M, Kitamura K, Nakada Y, Mori Y, et al.
Research Laboratories, Toyama Chemical Co., Ltd.

The Cohen Report
The Annals of Pharmacotherapy 2001 December, Volume 35 1
Peripheral Neuropathy Associated with Fluoroquinolones
Dr. Jay S Cohen
www .theannals,com

Peripheral neuropathy has been reported in patients receiving
quinolones. (Package insert warning updates, July 2004)

Peripheral Neuropathy Associated With Cipro November 2, 2001 New York

Peripheral neuropathy associated with Pefloxacin;

1990 Chan PC, Cheng IK, Chan MK, Wong WT. Br J Clin Pract. 1990 Dec;
44(12):564-7.
B. 1995 Vial T, Chauplannaz G, Brunel P, Leriche B, Evreux JC. 1995
[Exacerbation of myasthenia gravis by pefloxacin]
Rev Neurol (Paris). 1995 Apr;151(4):286-7. French.
PMID: 7481384 [PubMed - indexed for MEDLINE]
Sparfloxacin:

1992 Hinyokika Kiyo. 1992 Jan;38(1):121-8.
[Clinical and bacteriological study of sparfloxacin on bacterial
prostatitis]
[Article in Japanese]
*Suzuki K, Horiba M, Naide Y, Shinoda M, Hibi H.
Department of Urology, Hiratsuka City Hospita

Ciprofloxacin:

A. 1988 J Antimicrob Chemother. 1988 Aug;22(2):221-8.
PMID: 3053554 [PubMed - indexed for MEDLINE]

B. 1988 Moore B, Safani M, Keesey J.
Possible exacerbation of myasthenia gravis by ciprofloxacin.

C. Lancet. 1988 Apr 16;1(8590):882. No abstract available.
PMID: 2895386 [PubMed - indexed for MEDLINE]

D. 1988 J Antimicrob Chemother. 1988 Aug;22(2):221-8. No Authors
listed. Therapy of acute and chronic gram negative osteomyelitis with
Ciprofloxacin, Report from a Swedish Study Group
Ten adverse events related to ciprofloxacin treatment were observed in
nine patients; two phototoxic reactions, two cases of impaired colour
vision, and one each of exanthema, abdominal pain, malaise, drug
fever, peripheral neuropathy and eosinophilia.

E. 1990 Mumford CJ, Ginsberg L. 1990
Ciprofloxacin and myasthenia gravis.

F. BMJ. 1990 Oct 6;301(6755):818. No abstract available.
PMID: 2224281 [PubMed - indexed for MEDLINE]

G. 1992 Maddix DS, Stefani A. 1992
Comment: Myasthenia gravis and ciprofloxacin.
Ann Pharmacother. 1992 Feb;26(2):265. No abstract available.
PMID: 1554947 [PubMed - indexed for MEDLINE]

H. 1993 Rollof J, Vinge E. Ann Pharmacother. 1993 Sep;27(9):1058-9
Neurologic adverse effects during concomitant treatment with
Ciprofloxacin, NSAIDS and chloriquine, possible drug interaction.
"After indomethacin was reintroduced, the patient developed signs and
symptoms of peripheral neuropathy, which partially subsided when
ciprofloxacin was discontinued.

I. 1993 Neurologic adverse effects during concomitant treatment with
ciprofloxacin, NSAIDS, and chloroquine: possible drug interaction.Ann
Pharmacother 1993 Sep;27(9):1058-9.
PMID: 8219437 [PubMed - indexed for MEDLINE]

J. 1994 Singh J, Agarwal AK, Sudrania SP. 1994
Extrapyramidal syndrome following ciprofloxacin treatment.
Indian Pediatr. 1994 May;31(5):608-9. No abstract available.
PMID: 7875902 [PubMed - indexed for MEDLINE]

K. 1995 Zehnder D, Hoigne R, Neftel KA, Sieber R. Painful dysaesthesia
with ciprofloxacin. British Medical Journal. 1995 Nov 4;311(7014):
1204. "One case of peripheral neuropathy has been reported3 We report
two cases of generalised painful dysaesthesia due to ciprofloxacin, a
reaction not previously associated with this particular
fluoroquinolone

L. 1996 Hedenmalm K, Spigset O.
Peripheral sensory disturbances related to treatment with
fluoroquinolones.
J Antimicrob Chemother. 1996 Apr;37(4):831-7.
PMID: 8722551 [PubMed - indexed for MEDLINE] ( see below)

M. 1996 Roquer J, Cano A, Seoane JL, Pou Serradell A 1996
Myasthenia gravis and ciprofloxacin.
Acta Neurol Scand. 1996 Dec;94(6):419-20. No abstract available.
PMID: 9017031 [PubMed - indexed for MEDLINE]

N. PMID: 8865032 [PubMed - indexed for MEDLINE] Pastor P, Moitinho E,
Elizalde I, Cirera I, Tolosa E. Reversible oral-facial dyskinesia in a
patient receiving ciprofloxacin hydrochloride.
Ofloxacin:

A. 1993 Schmidt S, Cordt-Schlegel A, Heitmann R.
Guillain-Barre syndrome during treatment with ofloxacin.

B. J Neurol. 1993 Sep;240(8):506-7. No abstract available.
PMID: 8263558 [PubMed - indexed for MEDLINE]

C. 1993 Azevedo E, Ribeiro JA, Polonia J, Pontes C. 1993
Probable exacerbation of myasthenia gravis by ofloxacin.

D. J Neurol. 1993 Sep;240(8):508. No abstract available.
PMID: 8263560 [PubMed - indexed for MEDLINE]

Moxifloxacin:

A. 2002 Canadian Adverse Drug Reaction Newsletter, Volume 12, Issue 4,
October 2002

B. Optic Neuritis Moxifloxacin (Avelox)
2002 - Canadian Family Physician Nov 2002 - http :// www .cfpc.ca/cfp/2002/
Nov/vol48-nov-critical-2.asp

C. 2001 Canadian warnings for PN on Tequin and Avelox Ottawa
labeling. . Gatifloxacin. (Tequin(R)) Fluoroquinolone antibiotic.
Product monograph. Ottawa, Ont: Bristol-Myers Squibb Canada Inc; 2001.

D. Moxifloxacin hydrochloride (Avelox(R)). Fluroquinolone antibiotic.
2000 Product monograph. Ottawa, Ont: Bayer Inc; 2000. Adverse effects.
Gatifloxacin and moxifloxacin have tolerability profiles similar to
other fluoroquinolones. Adverse effects include gastrointestinal upset
(nausea, diarrhea, vomiting, and abdominal pain), headache, and
dizziness. Adverse effects reported since marketing are ventricular
tachycardia, renal failure, peripheral neuropathy, myositis, and
tendonitis.

20. Peripheral neuropathy associated with Avelox and Tequin 2002
What they say about Tequin and Avelox in Canada:
"Adverse effects. Gatifloxacin and Moxifloxacin have tolerability
profiles similar to other fluoroquinolones. Adverse effects include
gastrointestinal upset (nausea, diarrhea, vomiting, and abdominal
pain), headache, and dizziness. Adverse effects reported since
marketing are ventricular tachycardia, renal failure, peripheral
neuropathy, myositis, and tendonitis.26,27 26. Gatifloxacin. (Tequin(R))
Fluoroquinolone antibiotic. Product monograph.
Ottawa, Ont: Bristol-Myers Squibb Canada Inc; 2001.
Moxifloxacin hydrochloride (Avelox(R)). Fluroquinolone antibiotic.
Product monograph. Ottawa, Ont: Bayer Inc; 2000. "
http :// www .cfpc.ca/cfp/2002/Nov/vol48-nov-critical-2.asp

21. Peripheral sensory disturbances related to treatment with
fluoroquinolones. J Antimicrob Chemother 1996 Apr;37(4):831-7
Hedenmalm K, Spigset O.
Division of Clinical Pharmacology, Norrland University Hospital,
Sweden.

22. Levofloxacin-induced-neurological adverse events such as
convulsion, involuntary movement (tremor, myoclonus and chorea like),
visual hallucination in two elderly patients
Nippon Ronen Igakkai Zasshi. 1999 Mar;36(3):213-7.

23. Levofloxacin-induced delirium.
Clin Neurol Neurosurg. 2005 Feb;107(2):158-9.

24. Effects of fluoroquinolones on the locomotor activity in
rats
Thiel, R.; Metzner, S.; Gericke, C.; Rahm, U.; Stahlmann, R.
ARCHIVES OF TOXICOLOGY
2001; VOL 75; PART 1
36-41

25. The mechanism by which the fluorinated quinolones produce central
nervous system effects is unknown. Assessment of the effects of
ciprofloxacin and nalidixic acid on cerebral blood flow and metabolism
in healthy subjects by positron emission tomography.
Bednarczyk EM, Adler LP, Remler B, Goyer P, Wiznitzer M, Leisure GP,
Little D, Miraldi F.
Department of Medicine, Case Western Reserve University School of
Medicine, Cleveland, Ohio.


26. Neuropsychiatric manifestations and quinolones. Apropos of a case
[Article in French]
Rampa S, Caroli F.
l'Hopital Sainte-Anne, Paris.

27. Seizures Associated with Fluoroquinolones
The Annals of Pharmacotherapy: Vol. 36, No. 7, pp. 1162-1167.
Janine M Kushner, Howard J Peckman, and Clyde R Snyder

28. Peripheral neuropathy associated with fluoroquinolones
Lancet. 1992 Jul 11;340(8811):127. No abstract available.
PMID: 1352007; UI: 92310033
Drug Saf 1991 Jul-Aug;6(4):302-14
Prevention and management of drug-induced peripheral neuropathy.
Olesen LL, Jensen TS
Department of Neurology, Aalborg Hospital, Denmark.

29. Update on Drugs that May Cause or Exacerbate Myasthenia Gravis
McNamara
David R.P. Guay

30. CNS adverse effects are known to occur relatively commonly
with some fluoroquinolones
Lode H
Department of Chest and Infectious Diseases, City Hospital
Berlin-H-Heckeshorn, Berlin, Germany.

31. The symptoms and possible risk factors of peripheral
sensory disturbances related to
fluoroquinolones
Hedenmalm K, Spigset O
Division of Clinical Pharmacology, Norrland University Hospital,
Sweden.

32. Seizures Associated with Fluoroquinolones
The Annals of Pharmacotherapy: Vol. 36, No. 7, pp. 1162-1167.
Janine M Kushner, Howard J Peckman, and Clyde R Snyder

33. Psychotic reactions during administration of quinolones
Ned Tijdschr Geneeskd. 1994 May 21;138(21):1080-2.
[Article in Dutch]

34. Neurochemical studies on quinolone antibiotics: effects on
glutamate, GABA and adenosine
systems in mammalian CNS.
Pharmacol Toxicol. 1989 May;64(5):404-11. Related Articles, Links
Dodd PR, Davies LP, Watson WE, Nielsen B, Dyer JA, Wong LS, Johnston
GA.
Department of Pharmacology, University of Sydney, N.S.W., Australia.

35. Ciprofloxacin-caffeine: a drug interaction established
using in vivo and in vitro investigations.
Am J Med. 1989 Nov 30;87(5A):89S-91S. Related Articles, Links
Harder S, Fuhr U, Staib AH, Wolff T.
Department of Clinical Pharmacology, University Hospital, Frankfurt,
Federal Republic of Germany.

36. Potential neurologic toxicity related to ciprofloxacin
DICP, The Annals of Pharmacotherapy: Vol. 24, No. 2, pp. 138-140.
MT Schwartz and JF Calvert

37. Quinolone toxicity: methods of assessment.
Am J Med. 1991 Dec 30;91(6A):35S-37S.
Patterson DR.
Drug Safety Evaluation, Abbott Laboratories, Abbott Park, Illinois
60064.

38. Possible gatifloxacin-induced seizure.
Quigley CA, Lederman JR.
Department of Pharmacy Practice, College of Pharmacy, Midwestern
University Chicago, Downers Grove, IL 60515-1235, USA.
cquigl@midwestern.edu

39. Adverse events associated with pyrazinamide and levofloxacin in
the treatment of latent multidrug-resistant tuberculosis
Tina Papastavros, Lisa R. Dolovich, Anne Holbrook, Lori Whitehead, and
Mark Loeb

40. Quinolone Induced Psychosis

A. The Annals of Pharmacotherapy: Vol. 26, No. 7, pp. 930-931.
Ciprofloxacin-induced psychosis RR Reeves

B. Enferm Infecc Microbiol Clin. 1998 Jan;16(1):42. [Ciprofloxacin
and acute psychosis] [Article in Spanish] Zabala S, Gascon A,
Bartolome C, Castiella J, Juyol M.

C. Eur Psychiatry. 2003 Aug;18(5):262-3. Ciprofloxacin-induced acute
psychosis in a patient with multidrug-resistant tuberculosis.Norra C,
Skobel E, Breuer C, Haase G, Hanrath P, Hoff P. Department of
Psychiatry and Psychotherapy, University Aachen, Pauwelsstrasse 30,
52074 Aachen, Germany. cnorra@ukaachen.de

D. Arch Ophthalmol. 2002 May;120(5):665-6. Acute psychosis following
the use of topical ciprofloxacin. Tripathi A, Chen SI, O'Sullivan S.
Birmingham and Midland Eye Hospital, City Hospital, Dudley Road,
Birmingham B18 7QU, England.

E. Sir, We would like to caution against the use of ciprofloxacin with
non-steroidal anti-inflammatory ...ARL MEDFORD, AJ FRANCE - rcpe.ac.uk

F. ... PSYCHOSIS DUE TO CIPROFLOXACIN AND DICLOFENAC COMBINATION Sir,
We would like to caution against the use of ciprofloxacin with non-
steroidal anti-inflammatory ... http :// www .rcpe.ac.uk/publications/articles/journal 34 1/Letter.pdf

G. Am J Geriatr Psychiatry 11:470-471, August 2003 Letter
Gatifloxacin Precipitation of Psychosis in Alzheimer Disease Roy R.
Reeves, D.O., Ph.D.

H. Psychother Psychosom. 2001 Jan-Feb;70(1):58-9. Depression or
hypoactive delirium? A report of ciprofloxacin-induced mental disorder
in a patient with chronic obstructive pulmonary disease. Grassi L,
Biancosino B, Pavanati M, Agostini M, Manfredini R.

I. Am J Med. 1991 Apr;90(4):528-9. Acute psychoses associated with the
use of ciprofloxacin and trimethoprim-sulfamethoxazole. McCue JD,
Zandt JR. Tufts University School of Medicine, Boston, Massachusetts.

J. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. Antimicrobial-
induced mania (antibiomania): a review of spontaneous reports. Abouesh
A, Stone C, Hobbs WR. Southern Virginia Mental Health Institute,
Danville, VA 24541, USA.

K. CASE REPORTS
JM Kushner, HJ Peckman, CR Snyder - Ann Pharmacother, 2001 -
theannals,com
... such as headaches, dizziness, tremor, confu- sion, psychosis, and
seizures. ... two cases
of seizures following administration of levofloxacin and
ciprofloxacin. ...
Clinical features, diagnosis, and management of multiple drug-
resistant tuberculosis since 2002
F Drobniewski, Y Balabanova, R Coker - Current Opinion in Pulmonary
Medicine, 2004 - co-pulmonarymedicine,com
... These are all safe agents but can produce hepatitis, and a rare
case of ciprofloxacin
acute psychosis has been reported in the management of an MDRTB case
[34 ...

48. Generalized seizure and toxic epidermal necrolysis following
levofloxacin exposure.
Christie MJ, Wong K, Ting RH, Tam PY, Sikaneta TG.
University of Toronto, Nephrology Associates, Scarborough, Ontario,
Canada, and Scarborough General Hospital, Scarborough.

Additional References

The following citations have no abstract. The full text can be
purchased from the links provide or by contacting the author or the
publication cited:

1. Arch Intern Med. 2001 Oct