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
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
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
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
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)
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