Fluoroquinolone Antibiotics

I (usually) don't give a Flox

While I usually try to refute poorly researched bad press about important medications, there is one class that's come up lately that I don't feel like people have enough of a sense of wariness about.

Fluoroquinolones are a class of antibiotic with a few different names - in the US, you've probably heard of Cipro (ciprofloxacin), Avelox (moxifloxacin - fun to say with an English accent), and Levaquin (levofloxacin). Every now and then I have someone voice concerns about this after they read the package insert, but that's pretty rare, so I'll point out a few notes from the FDA about fluoroquinolones:

2004 - warning about risk of developing peripheral neuropathy (nerve pain or numbness in the extremities)

2008 - black box warning about permanent tendinitis and tendon rupture. This one got some press but has been largely forgotten. I blame the news cycle.

2011 - black box warning for exacerbating myasthenia gravis - a rare condition though so for most people not too important)

2013 - strengthened the warning about peripheral neuropathy, this time calling it potentially permanent and disabling

2016 - added a warning that it should only be used for treating COPD exacerbations, uncomplicated urinary tract infections and sinus infections in people with no other options

2018 - added three warnings on the risk of a hypoglycemic coma, mental health side effects (attention disturbance, memory impairment, agitation, disorientation, nervousness), and aortic dissection and aortic aneurysms.

So I think we're probably on the same page now in that these medications shouldn't be used if there's any other good alternative. I don't think this applies to eye drops in the same way as I know sometimes ofloxacin drops are used and don't get absorbed as much into the rest of the system.

If you have concerns that you or a loved one may have been affected by one of these things, unfortunately there is no test to determine the cause of any of the issues I mentioned above, it's more about thinking for the future and an ounce of prevention > pound of cure.

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen). Those are the over-the-counter ones. Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on. All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation. However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock. every other organ system that you have. The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before. For women who have had children, they generally know what a 10 is, but for men it's a little harder. When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?" The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth. The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance. Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child. For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was. Fortunately, there were researchers who had a yen to poke peopl...

Hey Doctor Scott ...

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