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Received Jul 1, 2017; Accepted Aug 20, 2017
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1. Long-Term Adverse Reactions Caused by Fluoroquinolones
Fluoroquinolones (FQ) belong to the group of broad-spectrum antibiotics, effective for both gram-negative and gram-positive bacteria. The most frequently prescribed drugs are ciprofloxacin (CIP), norfloxacin (NOR), and levofloxacin (LEV). FQs employ their antibacterial effect by preventing bacterial DNA from unwinding and duplicating which takes place by inhibition of bacterial topoisomerase and gyrase. For the last three decades, FQs played an important role in treatment of serious bacterial infections, especially hospital-acquired infections. However, due to the possibility of serious side effects, these drugs are not currently first-line medicines and their use becomes more restrictive and limited. FQs should be reserved for those who do not have alternative treatment options.
In 2016, the US Food and Drug Administration (FDA) updated warnings, using next “black box” for oral and injectable FQs. The authors showed that FQs, when used systemically, are associated with disabling and potentially permanent serious side effects. These side effects can involve the disruption of tendons, joins, muscles, nerves, nervous system disturbances, and even induction of type 2 diabetes. Due to the increasing number of reports about FQ toxicity and long-term complications, FDA has introduced significant restrictions on their use in recent years, particularly in children and in people aged 65 years.
1.1. Tendon Rupture
FQs are associated with a significant risk of tendonitis and tendon rupture. Stephenson et al. [1] showed in their review the incidence of tendon injury among those taking FQs to be between 0.08 and 0.2%. In...