FLUOROQUINOLONES

The following fluoroquinolones (generic and BRAND names) are discussed on this web site:

• ciprofloxacin (CIPRO, CILOXAN)
• enoxacin (PENETREX)
• gatifloxacin (TEQUIN)
• gemifloxacin (FACTIVE)
• levofloxacin (LEVAQUIN)
• lomefloxacin (MAXAQUIN)
• moxifloxacin (AVELOX)
• norfloxacin (NOROXIN, CHIBROXIN)
• ofloxacin (FLOXIN, OCUFLOX)
• sparfloxacin (ZAGAM)
• trovafloxacin (TROVAN)

One of the biggest-selling and most overprescribed classes of drugs in the United States is the family called fluoroquinolones. One clue that a drug your doctor wants to give you is in this class is the fact that the generic names of all such drugs approved in the United States include the sequence floxacin. These drugs have been alternatives for individuals allergic to, or with infections resistant to, other antibiotics. Some fluoroquinolones are commonly misprescribed for colds, sore throats, bladder infections, or community-acquired (as opposed to hospital-acquired) pneumonia. Whereas fluoroquinolones such as levofloxacin (LEVAQUIN) may be appropriate for treating community-acquired pneumonia, the fluoroquinolone ciprofloxacin (CIPRO) should not be prescribed for this purpose.

No antibiotic should be prescribed for the common cold, and penicillin or—if allergic—erythromycin is the drug of choice for a strep throat. In the past no fluoroquinolone has been the drug of choice for treatment of bronchitis or pneumonia that could be caused by pneumococcal bacteria, the most common cause of community-acquired pneumonia. Unfortunately, due to the inappropriate overuse of older, safer, and less expensive antibiotics and depending on the resistance of the pneumococcal bacteria in the area in which you live, your physician may prescribe one of the newer fluoroquinolones if you have community-acquired pneumonia.

A recent study illustrates the rampant, out-of-control dangers of misprescribing and overprescribing fluoroquinolone antibiotics, one of the most heavily advertised and expensive groups of antibiotics. In a study of the use of these drugs in the emergency rooms of two academic medical centers, 100 consecutive patients who were prescribed a fluoroquinolone were studied to find out if the use was appropriate according to the guidelines used at those institutions. Of the 100 patients, 81 (81%) were given the antibiotic for an inappropriate use, including 43 (53% of the 81 patients) for whom another antibiotic was the first-line treatment and 27 (33%) in whom there was no evidence of an infection. Of the 19 patients for whom the prescribing of this class of antibiotics was appropriate, only one patient was prescribed the right dose for the correct length of time.[1]

With very few exceptions, fluoroquinolones are not the drug of choice for other infections. A seven-day course of treatment with one of the fluoroquinolone drugs can be 7 to 21 times more expensive than equally effective (for most infections) treatment with other drugs, for example generic ampicillin or trimethoprim/sulfamethoxazole (BACTRIM/SEPTRA). Both resistance and allergy to one drug in this family usually cross to the rest of the fluoroquinolones and sometimes even occur during therapy.[2],[3] Overgrowth of normal bacteria may cause yeast infections, especially when antibiotics are used for long periods. The fluoroquinolones can cause central nervous system problems and psychosis.[4] Severe, even fatal, allergic reactions have happened after just one dose. Collapse of the circulatory system has occurred. As a group, the fluoroquinolones are expensive, resistance is increasing, and many effective alternatives are available.[5] The use of fluoroquinolones in animal feed is a major reason for resistance developing.