We present a case of lateral canthal tendon rupture that presented with an acute right lower eyelid ectropion in a young, renal compromised patient in the setting of recent fluoroquinolone use for pneumonia. [ncbi.nlm.nih.gov]

• Pain

  The persistent nature of the pain was the indication for surgical release of the extensor mechanism. After operation pain disappeared completely and the patients were able to return to their normal activities. [ncbi.nlm.nih.gov]

  KEB reported: “I was put on Levaquin over a year ago, and suffered much pain walking. I did not take the whole prescription, but enough to have done the damage, which is still giving me much pain in my feet and legs. [peoplespharmacy.com]

  […] feeling near the navel Constant, deep pain in the abdomen Back pain 9 The FDA and Fluoroquinolone Risks In 2008, the U.S. [recallcenter.com]

  About half of the patients who had serious side effects from fluoroquinolones said the side effects began after the first or second dose and included: Long-term pain Pain, burning, tingling, numbness, weakness Symptoms affecting tendons, muscles, and [webmd.com]

• Fatigue

  In many cases, even symptoms such as widespread body pain and fatigue, even to the point of causing disability, are symptoms of Fluoroquinolone toxicity. [fqresearch.org]

  BACKGROUND: Medication alert overrides remain persistently high over the past decade, influenced by factors such as "alert fatigue" and lack of provider acceptance. [ncbi.nlm.nih.gov]

  Mitochondrial dysfunction and oxidative stress are connected to a variety of ailments, from chronic fatigue syndrome to Alzheimer’s disease and obesity. [hormonesmatter.com]

  Characteristics of adverse reactions reported and recommendation if tendonitis occurs Serious side effects reported include tendonitis, tendon rupture, arthralgia, pain in extremities, gait disturbance, neuropathies associated with paraesthesia, depression, fatigue [gov.uk]

  The serious side effects include tendonitis, tendon rupture, arthralgia, pain in extremities, gait disturbance, neuropathies associated with paraesthesia, depression, fatigue, memory impairment, sleep disorders, and impaired hearing, vision, taste and [ema.europa.eu]

• Fishing

  Fish D N, Chow A T. The clinical pharmacokinetics of levofloxacin. Clin Pharmacokinet 1997; 32 (2): 101-19. [ Links ] 42.- Moise P A, Birmingham M C, Schentag J J. Pharmacokinetics and metabolism of moxifloxacin. [scielo.cl]

  Bertino J Jr, Fish D. The safety profile of the fluoroquinolones. Clin Ther 2000; 22: 798-817; discussion 797. [livertox.nih.gov]

  Bertino J Jr, Fish D. The safety profile of the fluoroquinolones. Clin Ther. 2000;22:798-817. 8. Yip C, Lee AJ. Gatifloxacin-induced hyperglycemia: a case report and summary of the current literature. Clin Ther. 2006;28:1857-1866. 9. [uspharmacist.com]

• Sepsis

  The risk of sepsis, retinal detachment, all-cause hospitalization, all-cause mortality, and sudden cardiac death did not differ significantly between groups. [jamanetwork.com]

  […] aortic disease, particularly as fluoroquinolones are often used for more serious infections and in older patients.11 Alternatively, a surveillance bias toward imaging patients with severe infection may have strengthened the observed association between sepsis [nps.org.au]

  […] monotherapy 46 (66) 51 (32) < 0.001 FQ in combination with other antimicrobials 24 (34) 106 (68) Syndrome Urinary 36 (51) 28 (18) < 0.001 Pulmonary 2 (3) 50 (32) < 0.001 Upper respiratory tract 4 (6) 9 (6) 1.000 Bacteremia 3 (4) 7 (4) 1.000 Fever or sepsis [bmcinfectdis.biomedcentral.com]

• Malaise

  A 77 years old woman who had a bite with eschar on her left arm, was admitted to emergency ward in our hospital, because of high fever, severe malaise, skin eruption, and consciousness disturbance beginning 5 days previously. [ncbi.nlm.nih.gov]

  In general, the symptoms usually appear in the arms and legs and include any or all of the following: numbness pain dizziness malaise weakness headaches anxiety and panic loss of memory psychosis tingling burning shooting pain Symptoms usually occur rapidly [vanweylaw.com]

  Jay Cohen, the following reaction rates were documented: 2 Nervous system symptoms occurred in 91 percent of patients (pain, tingling and numbness, dizziness, malaise, weakness, headaches, anxiety and panic, loss of memory, psychosis) Musculoskeletal [articles.mercola.com]

• Pneumonia

  or K. pneumoniae. [drugbank.ca]

  […] infections and in penicillin-allergic patients with pneumococcal pneumonia. [wwwnc.cdc.gov]

  Community Acquired Pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains*), Haemophilus influenzae, Moraxella catarrhalis, methicillin-susceptible Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, or Chlamydia [globalrph.com]

  The global emergence of Streptococcus pneumoniae resistance to fluoroquinolones is alarming and has grown to be a cause for significant concern worldwide. [ncbi.nlm.nih.gov]

  An AUC/MIC free drug ratio of 30 has been suggested for successful treatment of S pneumoniae infections, and levofloxacin has been shown to achieve greater than 99% eradication of S pneumoniae at an AUC/MIC free drug ratio of 32. [uspharmacist.com]

• Cough

  Predicting if or when a rupture will occur is difficult. 7 Symptoms of a thoracic aortic aneurysm may include: Chest tenderness or pain Back pain Cough Shortness of breath Hoarseness 8 Symptoms of an abdominal aortic aneurysm may include: A pulsating [recallcenter.com]

  Symptoms include fever, weight loss, and coughing up blood. [medical-dictionary.thefreedictionary.com]

  Its symptoms include fever, weight loss, and coughing up blood. Urinary tract— The passage through which urine flows from the kidneys to the outside of the body. [encyclopedia.com]

  […] with fever; blistering, itching, loosening, peeling, or redness of skin; bloody or cloudy urine; coldness; burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings; chills; chest pain; clay-colored stools; confusion; cough [drugs.com]

• Nausea

  Melinta reports that “The most common adverse reactions in patients treated with Baxdela were nausea (8%), diarrhea (8%), headache (3%), transaminase elevations (3%), and vomiting (2%).” [contagionlive.com]

  Among the serious reactions reported are: Retinal detachment, which can cause blindness Hallucinations Nausea and diarrhea Acute kidney failure Psychotic reactions Hearing problems Brain fog Painful rashes Disruptions to blood sugar metabolism Depression [articles.mercola.com]

  Common adverse reactions include nausea, diarrhea, headache, transaminase elevations, and vomiting. [ajpb.com]

  […] on an early drug called Naldixic Acid, and have been classified as chemotherapeutic agents… yes, the same kind of chemotherapeutic agents that are given to cancer patients that make them terrible, lose their hair, and become disabled from fatigue and nausea [fqresearch.org]

  Anxiety Fainting or dizziness Heavy sweating Nausea and vomiting Rapid, weak pulse Shortness of breath and trouble breathing when lying flat Difficulty swallowing 4 Symptoms of Aortic Aneurysm An aortic aneurysm is a weakened, bulging area of the aorta [recallcenter.com]

• Tachycardia

  Musculoskeletal symptoms in 73 percent of patients (tendon ruptures, tendonitis, weakness, joint swelling) Sensory symptoms in 42 percent of patients (tinnitus, altered visual, olfactory, and auditory function) Cardiovascular symptoms in 36 percent of patients (tachycardia [articles.mercola.com]

  QTC interval prolongation and polymorphic ventricular tachycardia in association with levofloxacin. Am J Med 1999; 107 (5): 528-9. [ Links ] 25.- Badshah A, Janjua M, Younas F, Halabi A R, Cotant J F. [scielo.cl]

• Heart Failure

  Third, the risk of heart failure, a negative control outcome, was not significant (eTable 13 in the Supplement). [jamanetwork.com]

• Photophobia

  A 55-year-old female was referred for a second opinion regarding her bilateral ocular pain, photophobia, and ocular hypertension. [ncbi.nlm.nih.gov]

• Skin Rash

  Quinolone antiobiotic side effects may include: Headaches Skin rash Gastrointestinal problems Allergic reactions 1 Other serious side effects of fluoroquinolone antibiotics may include: Seizures Hallucinations Potential liver damage, kidney damage, or [recallcenter.com]

  rashes and other skin reactions; thyroid problems; autoimmune diseases; blood sugar problems; and emotional problems, sometimes severe, among many other symptoms. [slweb.org]

  The common side effects of the fluoroquinolones are gastrointestinal disturbances, headaches, skin rash and allergic reactions. [livertox.nih.gov]

  problems with memory; problems with speech or speaking; problems with vision or hearing; rash; rash with flat lesions or small raised lesions on the skin; redness; redness of skin; redness, swelling, or soreness of tongue; scarring; seizures; sense [drugs.com]

  If any of the following side effects occur, check with a physician immediately: skin rash or other skin problems such as itching, peeling, hives, or redness fever agitation or confusion hallucinations shakiness or tremors seizures or convulsions tingling [medical-dictionary.thefreedictionary.com]

• Photosensitivity

  They can also give photosensitizations, even after a moderated exposure to light; photosensitization was particularly frequent with sparfloxacin. They can cause pharmacokinetic drug interactions. [pharmacorama.com]

  Diarrhea, leukopenia, anemia, and photosensitivity are uncommon. Rash is uncommon unless gemifloxacin is used for > 1 wk and is more likely to develop in women 40. Nephrotoxicity is rare. [merckmanuals.com]

  […] effects may include: Headaches Skin rash Gastrointestinal problems Allergic reactions 1 Other serious side effects of fluoroquinolone antibiotics may include: Seizures Hallucinations Potential liver damage, kidney damage, or bone marrow damage Angioedema Photosensitivity [recallcenter.com]

  Allergy Photosensitization Orthopedic side effects: cartilage damage, tendon damage with spontaneous tendon rupture. [urology-textbook.com]

  Less common but more severe side effects include QT prolongation, seizures, hallucinations, tendon rupture, angioedema and photosensitivity. [livertox.nih.gov]

• Confusion

  If you experience side-effects such as joint and muscle pain, numbness, tingling or confusion while taking a fluoroquinolone, consult a health-care professional. [cbc.ca]

  Consult a healthcare professional if you experience side effects such as joint and muscle pain, numbness, tingling or confusion while taking a fluoroquinolone. [healthycanadians.gc.ca]

  If you have been prescribed a fluoroquinolone antibiotic be sure to seek medical attention if you experience any side effects like unusual joint or tendon pain, muscle weakness, tingling or pricking sensation, numbness in arms or legs, confusion or hallucinations [goodrx.com]

  This is because one of the toxic aspects of these drugs is that they do Mitochondrial Damage, which can cause a confusing and diverse array of symptoms that often look like other diseases. [fqresearch.org]

  Some signs and symptoms of serious side effects include unusual joint or tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion, and hallucinations. [fda.gov]

• Agitation

  In the past year, FDA has warned about serious psychological effects on attention, memory and agitation. Aortic aneurysm is another very serious side effect. Patients have been sounding the alarm on these drugs for a long time. [peoplespharmacy.com]

  The reported adverse reactions include agitation tremor, hallucinations, psychosis and convulsions. [nps.org.au]

  The GABA receptor blockade caused by a fluoroquinolone results in a CNS stimulant effect, with neurological manifestations ranging from mild insomnia and agitation to hallucinations and seizures. [ 2 ] Anyone can suffer these side effects, but individuals [benzoinfo.com]

  If any of the following side effects occur, check with a physician immediately: skin rash or other skin problems such as itching, peeling, hives, or redness fever agitation or confusion hallucinations shakiness or tremors seizures or convulsions tingling [medical-dictionary.thefreedictionary.com]

  If any of the following side effects occur, the patient should consult a physician immediately: skin rash or such other skin problems as itching, peeling, hives, or redness fever agitation or confusion hallucinations shakiness or tremors seizures or convulsions [encyclopedia.com]

• Tremor

  The reported adverse reactions include agitation tremor, hallucinations, psychosis and convulsions. [nps.org.au]

  Studies have found that benzodiazepine-dependent individuals frequently experience depression, anxiety, psychosis, paranoia, severe insomnia, paraesthesia, tinnitus, hypersensitivity to light and sound, tremors, seizures, and suicidal thoughts upon exposure [benzoinfo.com]

  If any of the following side effects occur, check with a physician immediately: skin rash or other skin problems such as itching, peeling, hives, or redness fever agitation or confusion hallucinations shakiness or tremors seizures or convulsions tingling [medical-dictionary.thefreedictionary.com]

  Since that day I have suffered with seizures, convulsions, tremors, debilitating fatigue, muscle weakness, vision loss, severe neuropathic pain, vomiting, nausea, lack of appetite, tendon, and vein problems. [hormonesmatter.com]

  If any of the following side effects occur, the patient should consult a physician immediately: skin rash or such other skin problems as itching, peeling, hives, or redness fever agitation or confusion hallucinations shakiness or tremors seizures or convulsions [encyclopedia.com]

• Stroke

  Contraindications Quinolones are contraindicated if a patient has epilepsy, QT prolongation, pre-existing CNS lesions, or CNS inflammation, or the patient has suffered a stroke. They are best avoided in the athlete population. [omicsonline.org]

  Contraindications to Fluoroquinolones: Pregnancy and lactation Epilepsy Stroke Severe renal insufficiency QT-prolongation Caution in children: cartilage damage Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z References Auquer u.a. 2002 [urology-textbook.com]

Yet extensive medical workups do not find any other cause. Worse, there are no known effective treatments. Thus, these people suffer pain and disability for weeks, months, and years." [articles.mercola.com]

• Gram-Positive Bacteria

  These data imply that either DNA gyrase or topoisomerase IV can be the primary target of fluoroquinolones, although topoisomerase IV is commonly thought to be the primary target in gram-positive bacteria. [ncbi.nlm.nih.gov]

  The presence of the bulky bicycloamine substituent at the C-7 position prevents active efflux, associated with the NorA or pmrA genes seen in certain Gram-positive bacteria. [globalrph.com]

  In gram-positive bacteria, the main target for fluoroquinolones is DNA gyrase (topoisomerase II), an enzyme responsible for supercoiling of bacterial DNA during DNA replication; in gram-negative bacteria, the primary target is topoisomerase IV, an enzyme [pharmaxchange.info]

  Delafloxacin, the most recently approved fluoroquinolone, is the most broad-spectrum fluoroquinolone with activity against Gram-positive bacteria including MRSA, as well as atypical respiratory tract pathogens As fluoroquinolone use has increased, resistance [merckmanuals.com]

  Further fluoroquinolone development attempted to identify compounds with additional enhancements, such as improved pharmacokinetics and pharmacodynamics, greater activity against gram-positive bacteria, particularly S pneumoniae, and a more favorable [uspharmacist.com]

• Prolonged QT Interval

  QT interval prolonged QT interval, heart problems Duloxetine duloxetine toxicity NSAIDs convulsions with high doses of fluoroquinolones Speak with a pharmacist or doctor for a full list of potential interactions and how to avoid them. [drugwatch.com]

• Colitis

  To mitigate selection bias, we have also excluded people who have never used fluoroquinolone before or people with infectious colitis, enteritis or gastroenteritis. [ncbi.nlm.nih.gov]

  Good tissue penetration Most common renal elimination Side Effects of Fluoroquinolones: Gastrointestinal side effects: Nausea, vomiting, diarrhea, pseudomembranous colitis Neurotoxicity with headache, dizziness, psychosis and seizures. [urology-textbook.com]

  C. diff is the causative organism of antibiotic-associated colitis. Colonization of the intestinal tract occurs via the fecal-oral route and is facilitated by disruption of normal intestinal flora due to antimicrobial therapy. [todaysgeriatricmedicine.com]

Treatment failure with multiple doses of ofloxacin was observed in this case of gonorrhea. [ncbi.nlm.nih.gov]

Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality. Am J Gastroenterol 2010; 105: 2396-404. [livertox.nih.gov]

Fluoroquinolone antibiotics (such as olprofloxacin, pefloxacin, ofloxacin, norfloxacin, temafloxacin, etc.) have recently been implicated in the etiology of Achilles tendinitis and subsequent tendon rupture. [ncbi.nlm.nih.gov]

We are more and more being confronted with the advance of multidrug-resistant bacterial etiologies in our patients. [healio.com]

Epidemiology, University of Pennsylvania, Philadelphia, PA. [ncbi.nlm.nih.gov]

This volume covers their mechanisms of action, resistance mechanisms and epidemiology, pharmacokinetics, safety and clinical applications. [lavoisier.fr]

Pathophysiology: Bacterial Resistance Mechanisms Mutations of A Subunits of DNA gyrase Alterations of outer membrane porins Affects organism permeability VIII. [fpnotebook.com]

[…] surveillance data indicating that these medications were associated with subsequent tendonitis and tendon rupture. 4 Several large epidemiological studies have confirmed this association. 5, 6 Secondary cell biology and animal research has elucidated the pathophysiology [bmjopen.bmj.com]

Methods: MICs and mutation prevention concentrations were compared among E. coli strain TOP10 and two corresponding transformants harbouring the OqxAB-encoding plasmids. [ncbi.nlm.nih.gov]