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Are you still prescribing fluoroquinolones?


Want to know what's scaring me this Halloween week? Read on....

This week I had a patient who had seen her primary care provider prior to  coming to my travel clinic. She needed a vaccine her PCP couldn’t provide. While in my office I did a quick review of the information she had received about malaria chemoprophylaxis and self-treatment of traveler’s diarrhea. She had been given a prescription for ciprofloxin.  She said her PCP gave it to her because she also uses it for occasional UTI’s. She said several other people  going on this same tour of South East Asia had been given it by a variety of providers in my community.

I was very concerned about this because of safety and efficacy issues. First off, the FDA has several black box warnings against the use of fluoroquinolones. The most recent being for the increased risk of ruptures or tears in the aorta. Just a reminder here that an aortic dissection or rupture of an aortic aneurysm can lead to dangerous bleeding or even death. High-risk patients include those with peripheral atherosclerotic vascular diseases, hypertension, or genetic conditions such as Marfan’s syndrome and Ehlers-Danlos syndrome, as well as elderly individuals.

This is in addition to the potential for other irreversible serious adverse events. Fluoroquinolones should not be used in the first-line treatment for acute exacerbation of chronic bronchitis, acute uncomplicated cystitis, and acute sinusitis. Using fluoroquinolones as a first line agent for the above indications not only puts your patients at risk but is an increased risk of liability if an adverse reaction occurs for you, too.

Fluoroquinolones already have  black box warnings for tendinitis and tendon rupture, mental status changes, hypoglycemia, QTC prolongation, irreversible peripheral neuropathy, retinal issues, increased risk of c. difficile infection, and muscle weakness in patient with myasthenia gravis.

I counseled this patient about the risks of using ciprofloxin for traveler’s diarrhea and suggested azithromycin 500 mg one dose stat instead following the latest recommendations from the expert panel of the International Society of Travel Medicine.  Not only is ciprofloxin a high risk choice but many of the organisms that cause traveler’s diarrhea in many parts for the world are resistant to it. So, it wont even work.

Only use fluoroquinolones for anthrax prophylaxis, meningococcal meningitis prophylaxis, chronic bacterial prostatitis (not acute), or uncomplicated cervical and urethral gonorrhea or for conditions where no other antibiotic is available to you and counsel your patients accordingly about the potential risks associated with their use. 

For more information on travel health matters you may be asked out in primary care see our online CE programs at Oh, and Happy Halloween!


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