The US Food and Drug Administration (FDA) has recently reviewed the use of a major class of antibiotics by the name of fluoroquinolone and its associated side effects. FDA has stated that the use of fluoroquinolone as a wide spectrum antibacterial drug has shown to be accompanied by serious side effects and irreversible health conditions. It has been unanimously agreed that fluoroquinolone’s side effects have outweighed the drug’s benefits in many cases. It is, therefore, recommended to not prescribe fluoroquinolone drugs to patients with uncomplicated infections.

Doctors have commonly been prescribing fluoroquinolone containing drugs to patients with sinus, bronchitis and urinary tract infections. FDA has found that with the systemic use of fluoroquinolone that involves drug administered through capsules, tablets and injections, the side effects have reached to a noticeable point. Widely reported side effects include tendon rupture, muscle and joint problems which are accompanied by permanent damage to the nerves and central nervous system. Pricking sensations, severe muscular pain and hallucinations have also been reported, but such cases are fewer. In some cases, the side effects of the drug use are as grave as to cause disability in people.

With these widely reported side effects under consideration, FDA has suggested that doctors should refrain from prescribing fluoroquinolone for conditions that do not necessarily warrant this class of drugs and which can be treated by alternate options. The available fluoroquinolone drugs in the US include Levaquin (levofloxacin), Cipro (ciprofloxacin) and Avelox (moxifloxacin). Over 26 million Americans take these medications per annum. It comes as no surprise that the FDA recommendation will have an adverse impact on the profits of drug manufacturing companies. The decline in the popularity of drug will alarm the manufacturers, who have previously been making huge monetary profits with the high consumption of their fluoroquinolone drugs.

FDA has also asked the drug manufacturers to update the drug labels and medication guidelines to reflect the updated drug safety information. This has come as the interim response from FDA, until they dig further into the actual mechanisms that govern the initiation of these adverse effects on health. FDA has ensured to make the latest findings available to the public and bring a halt to all the speculations that surround the use of flouroquinolone.

What Does Fluoroquinolone Work Against?

Fluoroquinolones are broad-spectrum antibiotics that are classified as very powerful medications. They work against a large set of bacteria, including salmonella, E coli, gonorrhoeae, Haemophilus influenza, Moraxella catarrhalis, Mycoplasma sp, Chlamydia sp, Chlamydophila sp, Legionella sp, Enterobacteriaceae, Pseudomonas aeruginosa, Mycobacterium tuberculosis, atypical mycobacteria, and Methicillin-sensitive staphylococci. This drug’s activity against a range of bacteria misleads the doctors to prescribe it as the first line of defense against many infections. These infections are usually uncomplicated infections which do not necessarily warrant treatment with fluoroquinolone drugs. It is permissible, however, to switch to flouroquinolone drug if other classes of drugs do not work against the infection. Some doctors have pointed out this mistake in their fellow physicians and said that prescribing fluoroquinolones for common infections is synonymous to killing a fly with automated weapons.

What Are The Common Infections Where Fluoroquinolone Should Not Be Taken?

  • Sinus: Usually, fluoroquinolone is prescribed to patients who suffer from sinus. Most of the time, sinus is caused by a virus and antibacterial drugs are rendered useless against this virus. However, if the cause of sinus is a bacterial infection, it will start to show mitigated symptoms in a week’s time by the use of mild antibiotics such as amoxicillin.
  • Bronchitis: Similar to sinus, bronchitis is found to be caused by viral infections most of the times. However, for the patients of chronic obstructive pulmonary disease (COPD), who show severe symptoms and are hospitalized with the condition, can be administered flouroquinolone.
  • Urinary Tract Infections (UTI): In UTI, the person urinates less frequently and the urination is accompanied by a burning feeling or pain. Fever and bloody urine may also be experienced. However, these infections can be treated by other classes of mild antibiotics. In severe cases, where the strain becomes resistant to other antibiotics and infection starts to affect the kidneys, the use of fluoroquinolone is recommended.

What Is The Mode Of Action Of Fluoroquinolone?

The goal of a fluoroquinolonee drug is to stop the replication of pathogenic bacterial cells that have entered the human system. The mode of action makes use of the drug’s interaction with DNA gyrase and Topoisomerse IV, and both of these enzymes have a crucial role in DNA replication of the bacterial DNA. DNA gyrase is the primary drug target. In a given bacterium, the drug’s sensitivity to these two enzymes may differ. It is found that in gram negative bacteria, DNA gyrase shows higher sensitivity to the drug. On the other hand, in gram positive bacteria, topoisomerase is more sensitive to the drug. This is another reason why the drug is over-prescribed for an array of infections.

In the reported mode of action of the drug, the drug (flouroquinolone), bacterial DNA and DNA gyrase or topoisomerase form a ternary complex. This complex collides with the replication fork to turn into an irreversible ternary complex. The interaction between these three molecules induces structural changes in the DNA and the interaction enzyme that inhibits their respective activity, which in turn leads to the bacterial growth inhabitation by the drug.

Previously, in the years 2008 and 2013,FDA showed its concerns about the use of fluoroquinolone. However, it was in FDA’s meeting in November 2015, when the issue of reported side effects was addressed by the advisory committee in detail. People affected by the use of fluoroquinolone are asked to report to FDA MedWatch program.