Quinolones side effects

 Q: Name at least five side effects of fluoroquinolone that should be kept in mind for ICU/hospitalized patients? 

Answer:

1. prolong QTc interval which may become fatal with electrolyte abnormalities and concomitant use of other drugs causing QTc prolongation

2. increased risk of aortic aneurysm and dissection - this risk may persist for about eight weeks after use. It should be avoided in elderly patients with such a history or with severe vascular diseases such as Marfan syndrome

3. malregulation of glucose level causing hyper and/or hypoglycemia

4. increased risk of CNS effects including seizures, increased intracranial pressure (pseudotumor cerebri), lightheadedness, and tremors

5. increased risk of peripheral neuropathy - we included this side effect here as this can be irreversible

6. increased risk of psychiatric issues such as toxic psychosis, hallucinations, paranoia, agitation, restlessness, delirium, insomnia, anxiety, memory impairment, confusion, depression, and suicidal thoughts

7. increased risk of tendinopathy in patients on chronic steroid, renal insufficiency or solid organ transplant recipients

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References:

1. Stahlmann R, Lode H. Toxicity of quinolones. Drugs. 1999;58 Suppl 2:37-42. doi: 10.2165/00003495-199958002-00007. PMID: 10553703.

2. Friedrich LV and Dougherty R, “Fatal Hypoglycemia Associated With Levofloxacin,” Pharmacotherapy, 2004, 24(12):1807-12.

3. Khaliq Y and Zhanel GG. Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature. Clin Infect Dis. 2003;36(11):1404-1410

4. Lawrence KR, Adra M, Keir C. Hypoglycemia-Induced Anoxic Brain Injury Possibly Associated With Levofloxacin. J Infect. 2006;52(6):e177-e180.

5. Lee CC, Lee MG, Hsieh R, et al. Oral fluoroquinolone and the risk of aortic dissection. J Am Coll Cardiol. 2018;72(12):1369-1378. doi: 10.1016/j.jacc.2018.06.067