Oral fluoroquinolone exposure is with a small increase in the risk of peripheral neuropathy; according to findings from The Health Improvement Network (THIN) database. Peripheral neuropathy is one of several side effects that may occur following fluoroquinolone therapy, and other antibiotics have side effects, too. “Therefore, antibiotic stewardship is critically important to ensure these valuable medicines are used appropriately.”
Common fluoroquinolones include ciprofloxacin, levofloxacin, ofloxacin, and norfloxacin. Peripheral neuropathy has reported after fluoroquinolone use, but its incidence has remained uncertain. To investigate, Dr. Morales’s team used THIN data on more than 5,000 incident cases of peripheral neuropathy and more than 17,000 matched controls.
Incidence of peripheral neuropathy
The adjusted incidence of peripheral neuropathy was 47% (95% confidence interval, 1.13 to 1.92) higher among individuals currently exposed to oral fluoroquinolone; with a 3% increased risk for each additional day of current fluoroquinolone exposure, compared with unexposed individuals. The relative incidence of peripheral neuropathy was significantly elevating within 1 to 90 days of fluoroquinolone exposure and within 91 to 180 days of fluoroquinolone exposure.
After the exclusion of individuals with other conditions strongly associated with peripheral neuropathy; the association between current oral fluoroquinolone exposure and incident peripheral neuropathy was even stronger (a 64% increased risk). Fluoroquinolone exposure was with an additional 2.4 peripheral neuropathies per 10,000 patients per year; with an overall population-mean number needed to harm ranging from 304,167 patients for a 5-day course to 152,083 patients for a 10-day course to 54,315 patients for a 28-day course.
The absolute risk was greatest among men and among patients older than 60 years. How long these reactions last for could not be answered using our data. “Peripheral neuropathy seems to be a very rare side effect of exposure to fluoroquinolones, which are effective antibiotics.” “Reducing the duration of antibiotic therapy may reduce this risk,” he said.
Uncomplicated urinary infections
Despite the FDA cautions three years ago for the persistent-progressive multisymptom problems (and six years ago for peripheral neuropathy); most physicians seem unfamiliar with these problems. “These drugs continue to used for very minor infections; including uncomplicated urinary infections and the like, for which the FDA expressly recommends against these agents. Indeed, in many cases that come to our attention; it emerges there had no infection at all so that the patient’s life was changed for no just cause.
These agents should not prescribe cavalierly.” Dr. Mahyar Etminan of the University of British Columbia, in Vancouver, Canada, who have reported adverse effects with oral fluoroquinolone use; including peripheral neuropathy, told Reuters Health by email, “Fluoroquinolones should only prescribed to patients if absolutely necessary to mitigate serious fluoroquinolone adverse events, including peripheral neuropathy.”
“Although the absolute risk of peripheral neuropathy is low,” he said, “given that there are 30 million prescriptions of fluoroquinolones annually in the U.S., this means that roughly 7,200 patients might experience seriously; potentially serious and irreversible adverse events, such as peripheral neuropathy, annually.”