Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Abstract

The quinolone antibacterials are proving very useful in the management of infection, notably for the treatment of Gram-negative bacteria. With the increasing use of these drugs, adverse effects are being recognised more often and careful documentation is still required. In general, the quinolones are of low toxicity. Gastrointestinal adverse effects are the most common, and are usually mild; indeed, all adverse events are generally mild and resolve on withdrawal of the offending drug. Certain precautions and contraindications are apparent. Because drug-induced arthropathies occur in juvenile animals, quinolones should not be administered to pregnant or lactating women or to growing children, unless the clinical benefit outweighs the risk. Caution should also be observed in patients with previous epilepsy or severe cerebral arteriosclerosis. Neurological effects may require the use of appropriate neuro- and psychoactive drugs, as well as the withdrawal of the precipitating agent. Hypersensitivity reactions to a fluoroquinolone may require the use of antihistamines, and in some cases topical or systemic steroids, and may well preclude future use of a fluoroquinolone. Dose adjustments may be necessary in patients with reduced renal function, when the measurement of serum concentrations may be desirable. Interstitial nephritis, haematuria and acute renal failure are rare effects of quinolone therapy which will require appropriate management including withdrawal of the precipitating drug. Interactions with theophylline and warfarin are of clinical significance, and may require plasma concentration monitoring and adjustment of dosage.

A randomised, multinational study with sequential therapy comparing ciprofloxacin twice daily and ofloxacin once daily

“…Haemato!ogical abnormalities, including leukopenia and thrombopenia, have been reported in rare cases. The incidence of adverse events reported in this study was in the range published by other authors [3,4]. The frequency (ofloxacin/ciprofloxacin) of gastrointestinal symptoms was relatively low in this study (0.8/0.9%) compared to 5% reported by Rahm and Schacht [14].…”

“…Quinolones are only moderately active against S. pneumoniae and are not first-line therapy for the empirical treatment of RTI, except for nosocomial pneumonia, where gram-negative aerobic bacteria are usually the causative pathogens. An overall cure rate of between 70 and 90% has been reported for the treatment of lower RTI with quinolones [4,11]. The present study primarily treated patients with pneumonia and a low efficacy rate was a~chieved in both treatment groups (ITT: ofloxacin 63/ciprofloxacin 75%; PP: 55.2/71.9%).…”

“…The overall bacteriological response rate (ofloxacin 89.9%, ciprofloxacin 89.6%) was similar to the clinical cure rate. The most common side effects of ofloxacin and ciprofloxacin are gastrointestinal symptoms, central nervous reactions and allergic reactions [4]. The gastrointestinal symptoms include nausea, vomiting, and abdominal discomfort.…”

Urinary Tract Infection and Bacteriuria in Pregnancy

“…27,28 Quinolone exposure in animal models can induce abnormal cartilage development. 73 Interestingly, despite this risk, when pregnant women were exposed to quinolones, adverse events have not been consistently demonstrated. 31,74,75 Overall, this class of antimicrobials should be avoided in pregnancy if suitable alternatives are available.…”

Toxicity of quinolone antimicrobial agents

“…In humans, quinolones are reported to induce adverse CNS reactions such as dizziness, restlessness, confusion, depression, insomnia, drowsiness, somnolence, anxiety, sleep disorders, tremors, tremulousness, headache, and seizures (Christ et al, 1988;Zinner, 1989;Smythe & Rybak, 1989;Shah & Mulert, 1990;Norrby, 1991;Paton & Reeves, 1991;Geddes, 1993).…”