When to say ‘No’ to Cipro


When to say ‘No’ to Cipro

Back in 2016, the Food and Drug Administration (FDA) came out with an issue warning against the use of prescribing fluoroquinolones, a group of antibiotics approved to treat or prevent certain bacterial infections. The fluoroquinolone antibiotics include ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin (Floxin).

Of these fluoroquinolone antibiotics, Cipro is probably the best known, at one time frequently prescribed to treat common illnesses such as bronchitis, sinus infections, and urinary tract infections. The FDA however, recommended not using fluoroquinolone antibiotics to common infections as they could have the potential of causing permanent side effects of the tendons, muscles, joints, nerves, and central nervous system.  For some people, some of these symptoms occurred simultaneously.

Here are examples of side effects patients have reported:

·      Long-term pain

·      Pain, burning, tingling, weakness, numbness

·      Symptoms affecting tendons, muscles, and joints, including swelling, pain, and tendon rupture

·      Symptoms that lasted longer than a year

·      Depression or anxiety

·      Sensation changes or nerve damage in hands, arms, or legs

·      Dramatic impact on quality of life such as job loss, financial problems, and increased family tension

Due to patients suffering from health problems associated with taking fluoroquinolone antibiotics like Cipro, the FDA now advises against using them for the treatment of three infections: acute sinusitis, acute bronchitis, and urinary tract infections without complications, stating that the chance of serious side effects from them outweighed the benefits for some people.

Brief history of fluoroquinolones

The beginnings of the rise of fluoroquinolones began in 1962 with the introduction of quinolones, which resulted from alterations to a compound isolated from production of the antimalarial drug chloroquine. The drug in this class was nalidixic acid, approved for clinical use to treat urinary tract infections in 1965.  Over the years, changes to the chemical structure of quinolones included the addition of a fluorine molecule to the basic quinolone structure, resulting in what is now termed a fluoroquinolone.

The first fluoroquinolone approved for use in clinical medicine happened in the 1980s. Since that time, millions of people have been prescribed one of the fluoroquinolone antibiotics for various reasons. What stirred the pot on the risks of side effects from these antibiotics was the popularity of using them to treat infections. These powerful antibiotics work against a wide variety of bacteria and often do the job they are meant to do which is kill them off.  Because this class of antibiotics worked well for the intended use, this also led to massive overprescribing by doctors.

While fluoroquinolones play an important role in treating serious infections such as those caused by bacteria that are resistant to other types of antibiotics, in the case of less severe infections such as a mild bacterial sinus infection or uncomplicated bladder infection, the drugs should be reserved for second-line or even third-line treatment after other antibiotics have failed.

Three types of infections in which fluoroquinolones should not be used

1.  Sinus infections – The vast majority of sinus infections are caused by a virus, not bacteria. Antibiotics do not work against viruses. Even if bacteria are responsible, the infection will typically clear up on its own in a week or so. An antibiotic such as amoxicillin may be warranted if symptoms last longer than a week, start to improve and then worsen or if a person has a fever of 101.5 or higher.

2. Urinary tract infections – Individuals with symptoms such as frequent urination, pain or burning upon urinating, cloudy or bloody urine, and a fever, all indicating a urinary tract infection, may need an antibiotic to treat the infection. Several types of antibiotics are effective against uncomplicated bladder infections; fluoroquinolones are typically only necessary if the infection is resistant to other antibiotics or has spread to the kidneys.

3.  Bronchitis – Most cases of bronchitis or chest colds are caused by a virus and are not helped by taking an antibiotic. One exception to this are individuals with chronic obstructive pulmonary disease (COPD). They may benefit from antibiotics if they develop symptoms severe enough to require hospitalization.

Take home message

All antibiotics can have risks. Anytime a doctor prescribes an antibiotic, ask questions about potential side effects and weigh the pros and cons of using them.  The best advice is to not overuse or abuse the use of antibiotics. If the drug is unwarranted, prescribing it has no benefit and only exposes patients to needless risk.  By having a conversation with your doctor about antibiotics use, patients will be better served on balancing the benefits with the harms of them.