Antibiotics: Useful, Life-Saving, But Sometimes With Side Effects

Few would deny the benefits that antibiotics have brought to us. Try to imagine the world before penicillin (the first widely-distributed and effective antibiotic) was introduced. Without it, syphilis would still be a widespread and fatal disease, and many lives would have been lost to the infections that were cured by penicillin. At the same time, many people turned out to be allergic to penicillin – my father was one, and had to wear a Medic Alert bracelet, because a shot of penicillin would have killed him. Other people, especially epileptics, experienced seizures when exposed to penicillin. Just because an antibiotic works well for millions of people, that doesn’t mean that it doesn’t pose risks for many more.

Take the case of Levaquin (levofloxacin), in 2010, it was the best-selling antibiotic in the U.S. But last year its manufacturer was sued by more than 2,000 patients who suffered severe side effects or adverse reactions after taking it. Levaquin is one of a family of antibiotics called fluoroquinolones, along with its brother fluoroquinolones Cipro (ciprofloxacin) and Avelox (moxifloxacin). Many feel that these antibiotics pose a risk to many people, a risk that isn’t being adequately recognized by either the FDA or physicians.

Part of the problem is over-prescription

In theory, the use of fluoroquinolones should be limited to treating serious, potentially life-threatening infections, such as hospital-acquired pneumonia. In practice, these antibiotics are often prescribed for earaches, bronchitis, and sinusitis – conditions that could either go away on their own or be treated with less potent drugs or nondrug therapies. They are also commonly mis-prescribed for conditions that are caused by viruses, which antibiotics cannot kill. Pharmacological epidemiologist Mahyar Etminian, from the University of British Columbia, calls this overuse of antibiotics almost an epidemic, caused by “lazy doctors who are trying to kill a fly with an automatic weapon.”

The other part of the problem is side effects

Dr. Etminian went further in a study in The Journal of the American Medical Association. In it, he showed that the risk of a potentially blinding condition called retinal detachment was five times higher in users of fluoroquinolones than in non-users of the drugs. In a soon-to-be-published study, he documented a significantly increased risk of kidney failure among users of the drugs. Some users of Levaquin have been told that the adverse side effects they experienced after taking only a single dose of it will take over a year to resolve, if they ever go away at all.

There’s also the issue of fluoroquinolones causing increases of infections such as antibiotic-resistant Staphylococcus aureus and a severe form of diarrhea caused by Clostridium difficile. A study performed at a hospital in Quebec found that fluoroquinolones were responsible for 55% of all of the C. difficile cases it treated.

No long-term studies of fluoroquinolone users have been conducted

The FDA estimates that its reporting system for identifying adverse effects of antibiotics captures only 10% of the cases. One of the reasons for this is that many of the reported side effects of this class of antibiotics do not appear immediately, and may only appear months or years later, and thus escape being associated with fluoroquinolone use. At least six fluoroquinolone drugs – other than the three mentioned earlier – have been taken off the market, because they were proven to have unjustifiable risks of producing adverse effects. Yet the “big three” mentioned earlier are still available, and widely prescribed.

The Centers for Disease Control and Prevention have expressed strong concern that these drugs are being prescribed unnecessarily. Doctors can see – if they happen to notice them – “black box” warnings aimed at them warning of a potential link of these drugs to tendonitis, and about the drugs’ ability to block neuromuscular activity. But the drugs still carry no warnings or advisories to consumers, the end users of them.

What this means to you as a consumer, and a person concerned about your health, is that the next time you are prescribed a powerful antibiotic by your physician, you should talk to him or her about it and ask about the drug’s potential side effects, and how to detect them if they occur. You can also ask – especially if it’s one of the fluoroquinolone family of antibiotics – if there are alternatives that might be as effective, and safer.

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Juliette Siegfried, MPH

Juliette Siegfried, MPH, has been involved in health communications since 1991. Shortly after obtaining her Master of Public Health degree, she began her career at the National Institutes of Health in Bethesda, Maryland. Juliette now lives in Europe, where she launched ServingMed(.)com, a small medical writing and editing business for health professionals all over the world.

Juliette's resume, facebook: juliette.siegfriedmph, linkedin: juliettes, (+31) 683 673 767

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