Should these antibiotics be a last resort because of the rare but serious side effects?
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“Different antibiotics are different chemical entities, and some of them have very distinctive, well-known adverse events that are associated with them. Some of these adverse events occur commonly, such as pain on inoculation—not what we would call serious, but clearly uncomfortable, and you have to alert the patient.” -William Schaffner, MD
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In Alabama, the Department of Public Health is investigating 11 reported cases of adverse events associated with the antibiotic ceftriaxone.[]
But how common are side effects from antibiotics?
Related: Alabama physicians halt prescriptions of common antibioticWhat docs should know about antibiotic side effects
“Different antibiotics are different chemical entities, and some of them have very distinctive, well-known adverse events that are associated with them. Some of these adverse events occur commonly, such as pain on inoculation—not what we would call serious, but clearly uncomfortable, and you have to alert the patient,” William Schaffner, MD, an infectious disease expert at Vanderbilt University, tells MDLinx.
“There’s a class of antibiotics … called aminoglycosides. Gentamicin is one of those aminoglycosides. It has a tendency to impair kidney function. So, if you're giving one of those drugs, you have to monitor the patient's kidney function, and if you see something adverse, you have to modify the dose, increase the interval between doses, and/or reduce the dose itself. So many of these adverse events are extremely well-known. They're taught in medical school and schools of pharmacy and are anticipated, and we watch for them to make sure that they don't get worse when they happen to occur,” Dr. Schaffner says.
According to the CDC, one in five medication-related visits to the emergency room are due to reactions to antibiotics.[]
While some antibiotic side effects can be mild, others can be serious
A class of antibiotics known as fluoroquinolones can cause serious adverse events. FDA-approved fluoroquinolones include moxifloxacin (Avelox), levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, ofloxacin, delafloxacin (Baxdela) and gemifloxacin (Factive).[]
In 2018, the FDA required safety labeling changes for the drugs to include a boxed warning that highlights the risks of mental health side effects and blood sugar disturbances.
A boxed warning is the strongest warning required by the FDA, and indicates that medical studies show that a drug carries serious and potentially life-threatening adverse events.[][]
“Fluoroquinolones, including ciprofloxacin, have been associated with disabling and potentially irreversible serious adverse reactions from different body systems that can occur together in the same patient. Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion). These reactions can occur within hours to weeks after starting ciprofloxacin,” the warning reads on the drug label information []
In some people, medications like fluoroquinolone antibiotics have been associated with suicidal thoughts and completed suicide.
Dr. Schaffner says that while suicidal ideation is a possible side effect of drugs like fluoroquinolones, it is not something he has ever seen.
“I'm not sure if the chemical pathway for that has been established, but fortunately, that's exceedingly rare. In my career as a clinical infectious disease physician … I've used many, many fluoroquinolones and I've never seen that,” he says.