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Dear Colleague, August 4, 2015

The broad spectrum fluoroquinolone antibiotics (FQs) are some of the most

potent oral antibiotics in clinical use today. They are among the most often

prescribed antimicrobial agents.104Initially they were recommended as drugs of

last resort.FQs act by inhibiting bacterial DNA gyrase and topoisomerase IV. By

doing so they are bacteriolytic instead of bacteriostatic.

In this letter I would like to give you additional information regarding the adverse

effects (AEs) to FQs, which appear to happen with greater frequency and

chronicity than previously known.78The adverse effects of FQs are multi-systemic

in nature, co-occurring and therefore meeting the qualifications for a Syndrome:

the Fluoroquinolone Toxicity Syndrome (FTS).(76,77,78)

AEs to FQs can be either immediate or delayed.(1,6) They also can become

permanent in nature.(25) Tendonitis/tendinosis, gastrointestinal (nausea, diarrhea)

and central nervous system AEs (headache, dizziness) are most common.

The pathophysiology of the AEs to FQs are multifaceted:  Inhibition to and/or

disruption of the GABA receptor; Chelation of divalent ions such as magnesium

with disruption of cellular function; Oxidative stress;Harm to nuclear DNA, harm to

mitochondria and other cell organelles such as lysosomes;Depletion of

mitochondrial DNA; Direct toxicity;From a recent Mayo Clinic article; 82Iron

chelation leading to epigenetic effects through inhibition of dioxygenases,

inducing global epigenetic changes and inhibition of collagen maturation leading

to tendinopathy and liver injury.

A summary of possible adverse effects:

1. Fluoroquinolones may harm not only Achilles tendons, but also other tendons,

ligaments, connective tissue, cartilage, bones and muscles. (1-9, 98-103)

2. Fluoroquinolones may induce apoptosis of human body cells and thereby

harm their mitochondria by several mechanisms including oxidative stress.(29-37)

3. Fluoroquinolones may harm human DNA and may therefore be genotoxic.(38-49)

4. Fluoroquinolones have been used as chemotherapy or as an adjunct to

existing chemotherapy because of their apoptotic properties.(50-65)

5. Fluoroquinolones may harm the Central Nervous System,(18-28) the Peripheral

Nervous System(10-17) as well as many other endocrine and non-endocrine

organs.(83-97)

6. Fluoroquinolones appear to be able to either induce or worsen an existing

autoimmune diseases as well as give rise to an immune-allergic mediated

reaction.(66-75)

Patients may present with a wide array of symptoms: Joints: pain, swelling,

redness, fluid. Cartilage damage. Meniscus tears. Tendons: Pain, tears, rupture,

swelling. Ligament damage. Muscles: pain, weakness and wasting, involuntary

muscle contraction, twitching or jerks. Weight loss, nausea, diarrhea, hair loss,

visual abnormalities, severe fatigue, exertion inability, headache, feelings of head

pressure, dizziness, tremors, insomnia or sleep disturbance, hallucinations,

convulsions, anxiety, psychosis. neuropathy pain, tingling, prickling, burning,

“shocks,” buzzing, squeezing, or “pressure” in the arms, legs, body, or head,

paresthesia, blood pressure changes, autonomic neuropathy and sensory

disturbance, inability to sweat, excessive sweating, loss of bladder control,

orthostatic hypotension, tinnitus, dizziness, lightheadedness, fainting.

Hypersensitivity to pain or to light touch. Insomnia. Disturbance of glucose

regulation, signs of hypo or hyperglycemia. Elevated liver enzymes, liver failure,

kidney damage or failure. Heart: irregular heart beat with palpitations, QT

prolongation, torsade de point. Vision disturbance like floaters. Difficulty walking,

difficulty talking, difficulty swallowing, difficulty thinking.(76,108)

Acknowledgment of these often complex AEs is important for the patient. If AEs

to FQs are not viewed as inter-related, it is easy to miss the diagnosis of

FTS.Patients are then diagnosed as having fibromyalgia, somatoform or other

psychiatric illness because doctors who are unaware of the potential severity and

duration of some fluoroquinolone AEs. Of course It is also important to exclude

other pathology that was either provoked by or already existing but only become

apparent after the use of fluoroquinolone antibiotics.

It is my hope that many patients will benefit as medical professionals become

more aware of the information in this letter.Thank you for your time and

consideration.

Respectfully yours,

xxxxxxxxxxxxxxxx M.D.

Postscript and Accountability. To write this letter I have done a PUB Med and

Google scholar search for fluoroquinolones and the several adverse events. I

tried to refer to human research only as much as possible, although animal

studies may provide valuable data. I also tried to use recent publications except

when I thought older ones to be of importance.

Being harmed myself by the adverse events to these antibiotics, I wanted to find

out for myself what could be the explanation for my ongoing symptoms.

I also wanted to update the last “Dear Doctor” letter that was written in 2006 by

yet another physician who was harmed after the use of Fluoroquinolones

Antibiotics.(107)

As you might know medical literature post marketing has a tendency to

emphasize a more favorable outcome than is the reality. (105,106)Lately two citizens

petitions for two more black box warnings were submitted to the FDA by

professor Charles Bennet from SONAR : one for psychiatric EAs. (82) And one for

Mitochondrial damage. (81)

Tendons, muscles and bones:

1. Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for

athletes and sports clinicians and a systematic review of the literature.

Journal of Athletic Training. 2014 May-Jun;49(3):422-7.

http://www.ncbi.nlm.nih.gov/pubmed/24762232

2.Tsai WC, Hsu CC., et al. Ciprofloxacin up-regulates tendon cells to

express matrix metalloproteinase-2 with degradation of type I collagen.

J Orthop Res. 2011 Jan;29(1):67-73.

http://www.ncbi.nlm.nih.gov/pubmed/20602464

3. Kaleagasioglu F, Olcay E. Fluoroquinolone-Induced Tendinopathy:

Etiology and Preventive Measures.Tohoku J ExpMed. 2012;226(4):251-8.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Fluoroquinolone-

Induced+Tendinopathy%3A+Etiology+and+Preventive+Measures+2012

4. Finnoff JT, Smith J,. et al. Musculoskeletal complications of

fluoroquinolones: guidelines and precautions for usage in the athletic

population. PM R. 2011 Feb;3(2):132-42. Department of Physical Medicine and

Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine

Center, Rochester, MN 55905, USA.

http://www.levaquinadversesideeffect.com/wp-content/uploads/Documents/Hall-

2011.pdf

5.Eisele S, Garbe E. et al. Ciprofloxacin-related acute severe myalgia

necessitating emergency care treatment: a case report and review of the

literature. Int J ClinPharmacolTher. 2009 Mar;47(3):165-8.

http://www.ncbi.nlm.nih.gov/pubmed/19281725

6. Sendzik J, Lode H,. et al.Quinolone-induced arthropathy: an update

focusing on new mechanistic and clinical data. Int J Antimicrob Agents. 2009

Mar;33(3):194-200.

http://www.sciencedirect.com/science/article/pii/S0924857908003531

7. Maurin N. Fluoroquinolone-induced Achilles tendon rupture

Dtsch Med Wochenschr. 2008 Feb;133(6):241-4

http://www.ncbi.nlm.nih.gov/pubmed/18236349

8. Sendzik J, Shakibaei M., et al., Fluoroquinolones cause changes in

extracellular matrix, signalling proteins, metalloproteinases and caspase-3

in cultured human tendon cells. Toxicology. 2005 Aug 15;212(1):24-36.

http://www.ncbi.nlm.nih.gov/pubmed/15890441

9. O-Lee T, Stewart CE., et al.,Fluoroquinolone-induced arthralgia and

myalgia in the treatment of sinusitis. Am J Rhinol. 2005 Jul-Aug;19(4):395-9.

http://www.ncbi.nlm.nih.gov/pubmed/16171175

Peripheral Neuropathy:

10. Jacquelyn K. Francis, Elizabeth Higgins.Permanent Peripheral

Neuropathy: A Case Report on a Rare but Serious Debilitating Side-Effect

of Fluoroquinolone Administration.Journal of Investigative Medicine High

Impact Case Reports July-September 2014 vol. 2 no. 3

http://hic.sagepub.com/content/2/3/2324709614545225.full

11.Etminan M, Brophy JM, Samii., et al. Oral fluoroquinolone use and risk of

peripheral neuropathy. A pharmacoepidemiologic study. Neurology Today:

2 October 2014 - Volume 14 - Issue 19 - p 41–44

http://www.ncbi.nlm.nih.gov/pubmed/?

term=Oral+fluoroquinolone+use+and+risk+of+peripheral+neuropathy.

+A+pharmacoepidemiologic+study.

12. Jumma OK, Dick J., et al. Ciprofloxacin induced acute small fibre

neuropathy. Case report. Can J Neurol Sci. 2013 Jan;40(1):127-8

http://www.ncbi.nlm.nih.gov/pubmed/23427360

13. Ali AK. Peripheral neuropathy and Guillain-Barré syndrome risks

associated with exposure to systemic fluoroquinolones: a

pharmacovigilance analysis. Ann Epidemiol. 2015 Jun 19. pii: S1047-

2797(15)00224-0.

http://www.ncbi.nlm.nih.gov/pubmed/24472364

14. Pharmacovigilance Review FDA :Internal Report on possible permanent

PeripheralNeuropathy by Fluoroquinolones. Apr. 2013.

https://drive.google.com/file/d/0B093-_bthq2Db1c1cFlmd1hvRGM/view?

usp=sharing

15. Panas M, Karadima G., et al. Hereditary Neuropathy Unmasked by

Levofloxacin 2011. Ann Pharmacother. 2011 Oct;45(10):1312-3.

http://www.ncbi.nlm.nih.gov/pubmed/?

term=Hereditary+Neuropathy+Unmasked+by+Levofloxacin

16. Liang VY, Ghearing GR., et al. Carpal tunnel syndrome after

ciprofloxacin-induced tendinitis. J Clin Neuromuscul Dis. 2010 Mar;11(3):165-

6.

http://www.ncbi.nlm.nih.gov/pubmed/20215992

17. Cohen JS. Peripheral neuropathy associated with fluoroquinolones.

Ann Pharmacother. 2001 Dec;35(12):1540-7.

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term=Cohen+Peripheral+Neuropathy+associated+with+fluoroquinolones

CNS:

18. Wang JM, Zahedi S.A possible case of levofloxacin-associated amnesia,

depression, and paresthesia. Conn Med. 2014 Apr;78(4):229-30.

http://www.ncbi.nlm.nih.gov/pubmed/?

term=a+possible+case+of+levofloxacin+associated+amnesia+depression+and+p

aresthesia

http://connmed.csms.org/i/284691-apr-2014/38

19. Anthony J. Busti, M.D., Pharm.D., et al.What is the mechanism by which

the fluoroquinolone can increase a patients for developing a seizure or

worse epilepsy.Pharmacology Weekly. 2014

http://www.pharmacologyweekly.com/articles/fluoroquinolone-antibiotic-seizures-

epilepsy-CNS-ciprofloxacin-levofloxacin-moxifloxacin-gemifloxacin

20. Vikas Raj, Lt Cola., et al. Levofloxacin induced delirium with psychotic

features in a young patient. Med J Armed Forces India. 2013 Oct;69(4):404-5.

http://www.ncbi.nlm.nih. gov/pubmed/?

term=Levofloxacin+induced+delirium+with+psychotic+features+in+a+young+pati

ent

21. Chauhan U, Shanbag P., et al. Ofloxacin-induced hallucinations. Indian J

Pharmacol. 2013 Mar-Apr; 45(2): 189–190.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Ofloxacin-induced+hallucinations

22.Mittal SO, Machado DG., et al. Orofacial dyskinesia after moxifloxacin

treatment--a case with normal hepatorenal function and review of

literature.Clin Neuropharmacol. 2012 Nov-Dec;35(6):292-4.

http://www.ncbi.nlm.nih.gov/pubmed/?

term=Orofacial+dyskinesia+after+moxifloxacin+treatment--

a+case+with+normal+hepatorenal+function+and+review+of+literature

23. ArunKandasamy, D SrinathLevofloxacin-induced acute anxiety and

insomnia. Journal of Neuroscience in Rural Practice. 2012 May;3(2):212-4.

http://www.ncbi.nlm.nih.gov/pubmed/22865986

24.Tomé AM, Filipe A. Quinolones: review of psychiatric and neurological

adverse reactions.Drug Saf. 2011 Jun 1;34(6):465-88.

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%3A+review+of+psychiatric+and+neurological+adverse+reactions.+Tom

%C3%A9+AM1%2C+Filipe+A

25.Kiangkitiwan B, Doppalapudi A., et al. Levofloxacin-induced delirium with

psychotic features. Gen Hosp Psychiatry. 2008 Jul-Aug;30(4):381-3.

http://www.ncbi.nlm.nih.gov/pubmed/18585545/

26.Cheung YF, Wong WW., et al. Ciprofloxacin Induced Palatal Tremor

Palatal tremor, characterized by rhythmic contractions of the soft

palate.MovDisord. 2007 May 15;22(7):1038-43.

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27. Ajay Tripathi, MS, FRCS(Ed)., et al.Acute Psychosis Following the Use of

Topical Ciprofloxacin.JAMA Ophthalmol. 2002;120(5):665-666.

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28.Green MA, Halliwell RF. Selective antagonism of the GABA(A) receptor by

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90.

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phenylacetic+acid

Mitochondrial damage + Oxidative stress:

29. Ghaly H, Jörns A2.,et al. Effect of fluoroquinolones on mitochondrial

function in pancreatic beta cells. Eur J Pharm Sci. 2014 Feb 14;52:206-14.

http://www.ncbi.nlm.nih.gov/pubmed/24284031

30. Sameer Kalghatgi, Catherine S.,et al. Bactericidal Antibiotics Induce

Mitochondrial Dysfunction and Oxidative Damage in Mammalian Cells.

Science Translational Medicine. 2013 Jul 3;5(192):192ra85.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760005/

31. A Pharmacovilagance Review FDA Internal Report. April 17, 2013: § 8.6

https://drive.google.com/file/d/0BzLMHZg5q0Y3VkVJUmhxSlQtbWs/edit

32.Barnhill AE, Brewer MT., et al. Adverse effects of antimicrobials via

predictable or idiosyncratic inhibition of host mitochondrial components.

Antimicrob Agents Chemother. 2012 Aug;56(8):4046-51.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421593/

33. Li HT, Zhu SY., et al. The effect of moxifloxacin on apoptosis of airway

smooth muscle cells and mitochondria membrane potential. ZhonghuaJie

He He Hu Xi ZaZhi. 2011 Sep;34(9):684-7

http://www.ncbi.nlm.nih.gov/pubmed/22177495

34. V Talla and PR Veerareddy. Oxidative Stress Induced by

Fluoroquinolones on Treatment for Complicated Urinary Tract Infections in

Indian Patients.J Young Pharm. 2011 Oct-Dec; 3(4): 304–309.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249743/?report=printable

35. Hsiao CJ, Younis H., et al. Trovafloxacin, a fluoroquinolone antibiotic with

hepatotoxic potential, causes mitochondrial peroxynitrite stress in a mouse

model of underlying mitochondrial dysfunction. Chemico-Biologal

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http://www.ncbi.nlm.nih.gov/pubmed/20655887

36. Lowes DA, Wallace C., et al.The mitochondria targeted antioxidant MitoQ

protects against fluoroquinolone-induced oxidative stress and

mitochondrial membrane damage in human Achilles tendon cells. Free

Radic Research. 2009 Apr;43(4):323-8.

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37. Boya P, Andreau K,. et al. Lysosomal Membrane Permeabilization

Induces Cell Death in a Mitochondrion-dependent Fashion. The Journal of

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DNA damage and genotoxicity:

38. de Guidi G, Bracchitta G., et al. Photosensitization Reactions of

Fluoroquinolones and Their Biological Consequences.PhotochemPhotobiol.

2011 Nov-Dec;87(6):1214-29.

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term=Photosensitization+Reactions+of+Fluoroquinolones+and+Their+Biological+

Consequences

39.Koziel R, Szczepanowska J., et al. Ciprofloxacin inhibits proloferation and

promotes generation of aneuploidy in Jurkat cells.

J Physiol Pharmacol. 2010 Apr;61(2):233-9.

http://www.ncbi.nlm.nih.gov/pubmed/?term=.

+CIPROFLOXACIN+INHIBITS+PROLIFERATION+AND+PROMOTES+GENERA

TION+OF+ANEUPLOIDY+IN+JURKAT+CELLS

40.Pommier Y, Leo E., et al. DNA Topoisomerases and Their Poisoning by

Anticancer and Antibacterial Drugs. Chemistry and Biology. Volume 17, Issue

5, p421–433, 28 May 2010

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41.Sánchez G, Hidalgo ME., et al. Induced and photoinduced DNA damage

by quinolones: ciprofloxacin, ofloxacin and nalidixic acid determined by

comet assay. PhotochemPhotobiol. 2005 Jul-Aug;81(4):819-22.

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%3A+ciprofloxacin

%2C+ofloxacin+and+nalidixic+acid+determined+by+comet+assay

42. Viola G, Facciolo L., et al. Photophysical and Phototoxic Properties of

the Antibacterial Fluoroquinolones Levofloxacin and

Moxifloxacin.ChemBiodivers. 2004 May;1(5):782-801.

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nolones+Levofloxacin+and+Moxifloxacin

43. Zhang T, Li JL., et al. Compare two methods of measuring DNA damage

induced by photogenotoxicity of fluoroquinolones.ActaPharmacol Sin. 2004

Feb;25(2):171-5.

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genotoxicity+of+fluoroquinolones

44. Laurent Marrot, Jean PhillipeBelaïdi., et al.Molecular Responses

toPhotogenotoxic Stress Induced by the Antibiotic Lomefloxacin in Human

Skin Cells: From DNA Damage to Apoptosis.Journal of Investigative

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%282003%29+121%2C+596%E2%80%93606%3B+doi%3A10.1046%2Fj.1523-

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Use as Chemotherapy:

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http://www.ncbi.nlm.nih.gov/pubmed/9085565

64. Lawrence JW, Claire DC., et al. Delayed cytotoxicity and cleavage of

mitochondrial DNA in ciprofloxacin-treated mammalian cells.MolPharmacol.

1996 Nov;50(5):1178-88.

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65. Gootz TD, Barrett JF., et al. Inhibitory effects of quinolone antibacterial

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Autoimmunedisease/immunoallergic-allergicreaction:

66. García Juárez I, Miquel R., et al. Levofloxacin-induced autoimmune

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67. Wang SH, Xie YC., et al. Fluoroquinolone associated myasthenia gravis

exacerbation: clinical analysis of 9 cases.Zhonghua Yi XueZaZhi 2013 May

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68. Dana M. Blyth, Elizabeth Markelz., et al. Cutaneous leukocytoclastic

vasculitis associated with levofloxacin therapy.Infect Dis Rep. 2012 Jan 2;

4(1): e11.

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69. Anty R, Hastier P., et al. Unusual evolution of ciprofloxacin-induced

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70. Garbe E, Andersohn F., et al. Drug induced immune haemolyticanaemia

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71. Jones SC, Sorbello A., et al. Fluoroquinolone-associated myasthenia

gravis exacerbation: evaluation of postmarketing reports from the US FDA

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hemorrhagic vasculitis. Ann Vasc Surg. 2010 Feb;24(2):256.e13-5.

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73. Tuccori M, Guidi B et al. Severe thrombocytopenia and

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74. Lim S, Alam MG.Ciprofloxacin-induced acute interstitial nephritis and

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Divers/Research:

76. The UCSD Fluoroquinolone Effects Study.

Professor Beatrice A. Golomb, the University of California, San Diego.

http://www.fqstudy.info/Fluoroquinolone_Effects_Study/Study_Information.html

http://www.fqstudy.info/Fluoroquinolone_Effects_Study/About_Dr._Golomb.html

77. Megan Strauchman and Mark W. Morningstar., et al. Fluoroquinolone

toxicity symptoms in a patient presenting with low back pain.ClinPract. 2012

Oct 12; 2(4): e87.

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78. Cohen. Jay S. Fluoroquinolone Toxicity Syndrome: a letter to the senate

committee on Health, Education & Labor.

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79. Cohen. Jay S. An Open Letter To Congressman Holt on Severe,

Disabling Reactions Linked to Cipro, Levaquin, and Other Fluoroquinolone

Antibiotics

http://medicationsense.com/articles/jan_mar_04/congress_ltr.php

80. Bennet C. Citizen petition to FDA for psychiatric side effects.

University of South Carolina. Southern Network on adverse Reactions. SONAR.

September 8, 2014.

https://drive.google.com/file/d/0B093-_bthq2DOTVTQmdBYXYzZ0k/view?

usp=sharing

81. Bennet, C. Citizen petition to FDA for mitochondrial warning.

University of South Carolina. SONAR. June 18, 2014.

https://drive.google.com/file/d/0B093-_bthq2DUDZlV0tCV2ZjWk0/view?

usp=sharing

82.Badal S, Her YF., et al. Non-antibiotic effects of fluoroquinolones in

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Endocrine organs and other organ involvement:

83. Kabbara WK, Ramadan WH., et al.Evaluation of the appropriate use of

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84. Chou HW, Wang JL, et al. Risk of severe dysglycemia among diabetic

patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan.

Clin Infect Dis. 2013 Oct;57(7):971-80.

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85. Sherrie L. Aspinall., et al. Severe Dysglycemia with the Fluoroquinolones:

A Class Effect? Clin Infect Dis. (2009) 49 (3): 402-408.

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http://cid.oxfordjournals.org/content/49/3/402.full

86. S Vallurupalli,* G Huesmann., et al. Levofloxacin-associated

hypoglycaemia complicated by pontine myelinolysis and

quadriplegia.Diabet Med. 2008 Jul; 25(7): 856–859.

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87. Lu ZK1, Yuan J., et al.Cardiac risks associated with antibiotics:

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88. Rao GA1, Mann JR., et al, Azithromycin and levofloxacin use and

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89. Pugi A, Longo., et al. Cardiovascular and metabolic safety profiles of

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90. Falagas ME, Rafailidis PI., et al. Arrhythmias associated with

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91. Iannini PB, Doddamani S., et al. Risk of torsades de pointes with non-

cardiac drugs. Prolongation of QT interval is probably a class effect of

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92. Levine C, Trivedi A., et al.Severe ductopenia and cholestasis from

levofloxacin drug-induced liver injury: a case report and review. SeminLiver

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93. Leise MD, Poterucha JJ., et al. Drug-induced liver injury. Mayo Clinic

Proceedings. 2014 Jan;89(1):95-106

http://www.ncbi.nlm.nih.gov/pubmed/24388027

94. J. Michael Paterson, MSc, Muhammad M et al. Fluoroquinolone therapy

and idiosyncratic acute liver injury: a population-based study. CMAJ. 2012

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95.Brennan Eadie, MD, PhD1; MahyarEtminanEvidence Linking Some

Fluoroquinolones to Uveitis Grows JAMA Ophthalmology. 2014 JAMA

Ophthalmol. 2015;133(1):81-84

96. Etminan M, Forooghian F. et al. Oral fluoroquinolones and the risk of

retinal detachment. JAMA. 2012 Apr 4;307(13):1414-9

http://www.ncbi.nlm.nih.gov/pubmed/22474205

97.Mehlhorn AJ, Brown DA.Safety concerns with fluoroquinolones.

Ann Pharmacother. 2007 Nov;41(11):1859-66. Epub 2007 Oct 2.

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98. Cooper JG, Harboe K., et al.Ciprofloxacin interacts with thyroid

replacement therapy.BMJ. 2005 Apr 30;330(7498):1002.

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99. Yang SD1, Bai ZL., et al. Levofloxacin increases the effect of serum

deprivation on anoikis of rat nucleus pulposus cells via Bax/Bcl-2/caspase-

3 pathway.ToxicolMech Methods. 2014 Dec;24(9):688-96

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100. Bai ZL, Chen Q., et al. ToxicEffects of Levofloxacin on Rat Annulus

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101. Wang L, Wu Y., et al. Cytotoxic effects of the quinolone levofloxacin on

rabbit meniscus cells. J ApplToxicol. 2014 Aug;34(8):870-7

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102. Khan M, Ortega LM1., et al. Crystal-induced acute kidney injury due to

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Epub 2015 Jan 1.

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103. Argirov M1, Ricken G., et al. Acute interstitial nephritis associated with

moxifloxacin use.ClinTher. 2005 Aug;27(8):1260-3

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Miscellaneous:

104.Linder JA, Huang ES., et al. Fluoroquinolone prescribing in the United

States: 1995 to 2002. Am J Med. 2005 Mar;118(3):259-68.

http://www.ncbi.nlm.nih.gov/pubmed/?

term=Fluoroquinolone+prescribing+in+the+United+States%3A+1995+to+2002

105. Holleman F, Uijldert M., et al. Productivity of authors in the field of

diabetes: bibliographic analysis of trial publications. BMJ. 2015 Jul

1;351:h2638.

http://www.ncbi.nlm.nih.gov/pubmed/?

term=Productivity+of+authors+in+the+field+of+diabetes

%3A+bibliographic+analysis+of+trial+publications.+The+BMJ%2C+July+2015

106. Concerns about industry dominance in diabetes research.

http://www.sciencedaily.com/releases/2015/07/150701214541.htm

107. Dear doctor letter Todd Plumb M.D. 2006.

https://attachment.fbsbx.com/file_download.php?

id=555395031193358&eid=ASvcPLIkVLFBc55rTFuAXaLrOs0E6kwwKQHDNwd

YtCCmZ-lH7kOoEQiJ1rIza5qz9Rc&inline=1&ext=1438663227&hash=ASv8lA-

496ZB5Apz

108. Physicians’ Desk Reference. 2015