Which antibiotics have the worst side effects

Fluoroquinolone Antibiotics: Warning to Doctors

Status: 04/15/2019 10:43 a.m. | archive
Fluoroquinolone antibiotics can have serious side effects.

The Federal Institute for Drug Safety and Medical Devices (BfArM) warns against uncritical handling of certain antibiotics, so-called fluoroquinolones, in a so-called red-hand letter to doctors and hospitals. These antibiotics should only be prescribed on a case-by-case basis after a careful risk-benefit assessment - taking into account all risks and restrictions on use.

Side effects of fluoroquinolones

In Germany, the active ingredients ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin are affected. They have long been associated with serious side effects that can occur after just a few tablets:

  • Tingling of the face and hands
  • Numbness, pain and tears in the tendon area
  • muscle pain
  • Anxiety and panic attacks
  • Liver damage

The side effects can persist for months or even after stopping the drug. And not only that: New studies show that those affected have an increased risk of developing an aortic aneurysm after taking fluoroquinolones.

The risk of rupture of the aorta increases

An aortic aneurysm is a spindle-shaped or sac-shaped enlargement of the main artery (aorta), which can arise in all sections of the artery. If the weakened vascular wall tears, the person affected can bleed to death internally in a very short time. In some cases, fluoroquinolones can change the vascular wall in such a way that a vascular sagging occurs and, in the worst case, tears.

The walls of the main arteries have a structure similar to that of the Achilles tendon. Anyone who has problems with the Achilles tendon after taking fluoroquinolones could also have problems with the aorta. The extent to which the risk increases depends on the duration of the antibiotic therapy. One study found that after using a fluoroquinolone for 14 days, the risk almost tripled.

EU already restricted indication for fluoroquinolones

The side effects are listed at the bottom of the medication package insert as "rare side effects". Tens of thousands of cases are already listed in the EU side effect databases for this group of antibiotics. After a risk-benefit analysis, the authorities restricted the indications of norfloxacin, ciprofloxacin and moxifloxacin in 2008, followed by levofloxacin in 2012.

Fluoroquinolones only for life-threatening illnesses

In practice, however, the warnings are often not taken seriously enough, experts criticize. Many resident doctors also prescribe fluoroquinolones for relatively harmless respiratory diseases or non-life-threatening urinary tract infections. In hospitals, these antibiotics are usually only used for life-threatening infections if no other drugs are available.

Immediately discontinue medication if side effects occur

In 2016, the FDA in the USA ordered the manufacturers of fluoroquinolone antibiotics to indicate the rare but massive side effects in bold type on the instruction leaflets. If other antibiotics are available for therapy, the authorities advise doctors not to prescribe fluoroquinolones. If side effects occur, a fluoroquinolone should also be discontinued immediately and switched to another antibiotic.

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Experts on the subject

Dr. Stephan Kurz, cardiac anesthetist, head of the aorta research group
German Heart Center Berlin
Augustenburger Platz 1
13353 Berlin
(030) 45 93 20 00
www.dhzb.de

Dr. Tobias Pottek, chief physician
Urology Clinic
Vivantes Clinic Am Urban
Dieffenbachstrasse 1
10967 Berlin-Kreuzberg
(030) 130 22 63 01
www.vivantes.de

Heike Hilgarth, pharmacist
Intensive Care Clinic
Center for Anaesthesiology and Intensive Care Medicine
University Hospital Hamburg-Eppendorf
Martinistrasse 52
20246 Hamburg
www.uke.de

Dr. Hans Klose, chief physician
Department of Pneumology
II. Medical clinic and polyclinic
University Medical Center Hamburg Eppendorf
Martinistrasse 52
20246 Hamburg
www.uke.de

Prof. Dr. Dr. Ingolf Cascorbi, director
Institute for Experimental and Clinical Pharmacology
University Medical Center Schleswig-Holstein - Campus Kiel
Arnold-Heller-Strasse 3
24105 Kiel
www.uksh.de

additional Information
Self-help discussion forum on the Internet
www.fluorchinolone-forum.de

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