Fluoroquinolones, like Levaquin (levofloxacin) and Cipro (ciprofloxacin), are a popular class of antibiotics that are used to treat a variety of infections. While these antibiotics are highly effective, it’s important to be aware of the pros and cons associated with their use. Patients and providers should have a conversation about these side effects and potential alternative antibiotics before beginning therapy.
Pros:
- Rapid action: Fluoroquinolones act quickly to relieve symptoms which can lead to faster recovery. They are commonly used for infections like pneumonia and cellulitis, where prompt treatment leads to shortened recovery and less hospital time.
- Effective against many types of infections: Fluoroquinolones are useful in a wide range of bacterial infections, including respiratory, urinary tract, skin, and gastrointestinal infections. They often work for resistant bacteria when other antibiotics fail.
- Can be given orally: Most fluoroquinolones are conveniently available in tablet form. These drugs are a good option for those who don’t like injections. Oral formulations are easier for home therapy and sometimes allow patients to be discharged from the hospital sooner.
Cons:
- Risk of adverse effects: Perhaps the most significant concern with fluoroquinolones is the risk of adverse effects. These drugs can cause a wide range of side effects including diarrhea, nausea, headaches, and dizziness. More serious side effects, such as tendonitis, tendon rupture, and nerve damage, can also occur. The U.S. Food and Drug Administration (FDA) has issued a “black box warning” for fluoroquinolones due to their association with serious, sometimes permanent, side effects, like tendon rupture. High-intensity exercise can increase the likelihood of tendon rupture. To be safe, consider taking a break from exercise until you finish your round of fluoroquinolone antibiotics.
- Secondary infections: Most broad-spectrum antibiotics, like fluoroquinolones, carry a risk for a secondary bacterial infection of the gut called Clostridium difficile-associated diarrhea. This can be difficult to treat. Probiotics may help to prevent this infection, but studies have been conflicting.
- Multiple drug interactions: Fluoroquinolones can interact with other medications, potentially reducing their effectiveness or causing harmful interactions. It’s crucial to inform your healthcare provider of all medications, supplements, and herbs you are taking to minimize this risk.
- Overuse and antibiotic resistance: Overuse and inappropriate prescribing of fluoroquinolones can contribute to antibiotic resistance, a global health concern. When bacteria become resistant to antibiotics, it becomes harder to treat all infections, posing a risk to public health.
- Not suitable for all patients: Certain individuals, such as pregnant or nursing women, children, and people with certain medical conditions, may not be suitable candidates for fluoroquinolone therapy. In such cases, alternative antibiotics may be recommended.
Key Points:
Fluoroquinolones are potent antibiotics with a broad range of applications in the treatment of bacterial infections. While they offer several advantages, such as rapid action and versatility, patients must be aware of the potential drawbacks associated with these drugs. The risk of adverse effects, including serious side effects, underscores the importance of cautious use and thorough discussions with healthcare providers before starting fluoroquinolone therapy. In many cases, alternative antibiotics with a more favorable safety profile may be considered. Ultimately, the decision to use fluoroquinolones should be made on a case-by-case basis, weighing the benefits and risks to ensure the best possible outcome for the patient’s health.
References:
- FDA Medwatch. https://www.fda.gov/drugs/information-drug-class/fluoroquinolone-antimicrobial-drugs-information
- Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train. 2014 May-Jun;49(3):422-7. doi: 10.4085/1062-6050-49.2.09. Epub 2014 Apr 24. PMID: 24762232; PMCID: PMC4080593.
- Mills JP, Rao K, Young VB. Probiotics for prevention of Clostridium difficile infection. Curr Opin Gastroenterol. 2018 Jan;34(1):3-10. doi: 10.1097/MOG.0000000000000410. PMID: 29189354; PMCID: PMC6335148.