Overuse of antibiotics is jeopardizing the usefulness of essential drugs. sign now

Overuse of antibiotics is jeopardizing the usefulness of essential drugs.


To: U.S. Food and Drug Administration
Medical Director for CDC's National Campaign for Appropriate Antibiotic Use:
Richard Besser, M.D.

"The biggest problem is inappropriate prescribing of antibiotics. Tens of millions of antibiotics prescribed in doctor's offices are for viral infections, which are not treatable with antibiotics.
There are many reason's for this, including demand from patients, time pressure on physicians, and diagnostic uncertainty. The patient wants to get back to work or get the child back to school, and the doctor wants the patient to feel satisfied with treatment.
The result is over-prescribing of antibiotics, resulting in the development of resistant bacteria. The best way to combat this practice is to educate the physicians and the public to decrease both demand and over prescribing In addition, providing clinicians with better means of diagnosing respiratory tract infections may remove some of the uncertainty that promotes over prescribing."

____________________________________________________________________________



An Open Letter To Congressman Holt on Severe, Disabling Reactions Linked to Cipro, Levaquin, and Other Fluoroquinolone Antibiotics


Dear Congressman Holt,

Thank you for taking the time to speak with people concerned about, or injured from, reactions associated with fluoroquinolone antibiotics (e.g. Levaquin, Cipro, Floxin, Tequin). I am the author of a study about severe, long-term fluoroquinolone reactions published in the December 2001 issue of the Annals of Pharmacotherapy.1 Actually, the publisher and I pre-released this article in October 2001, during the anthrax scare when Cipro was being prescribed indiscriminately and without warnings to patients. Within days of publication of my paper, the U.S. Centers for Disease Control changed their guidelines, placing the antibiotics doxycycline and penicillin above Cipro as the preferred treatments for anthrax exposure. Doxycycline and penicillin are associated with fewer severe side effects than fluoroquinolones, and they are not linked with the devastating, disabling, long-term reactions that my study identified.

These severe reactions are occurring in patients who are usually healthy, active, and young. Most often, the antibiotics are prescribed for mild infections such as sinusitis, urinary or prostate infections. Most reactions occur very quickly, sometimes with just a few doses of the fluoroquinolone antibiotic. Reactions are acute, severe, frightening, and often disabling. In most cases, side effects are multiple, involving many systems of the body. In my study, nervous system symptoms occurred in 91\% of patients, musculoskeletal 73\%, sensory system 42\%, cardiovascular 36\%, skin 29\%, gastrointestinal 18\%.

These numbers do not adequately capture the severity and permanence of these reactions. Here are some examples:

Male, age 36, previously in good health, received Cipro for possible urinary infection: Chronic, debilitating multi-focal neuropathy, fibromyalgia, chronic fatigue, gastrointestinal problems, heart arrhythmia requiring pacemaker, carpal tunnel syndrome, chronic multiple joint pains, chronic pain. Functional ability: disabled. Duration: 5 years (patient now age 41).

Female, age 32, previously in good health, received Cipro for urinary infection: After 5 days, developed pain in wrists, neck, back, knees, hips, elbows, shoulders, and Achilles tendons. Having difficulty writing. Medical workup normal. Functional ability: greatly limited.

Female: age 47, previously in good health, received Levaquin for sinusitis: Within 2 days developed joint pain (severe in hands), insomnia, severe agitation, weakness, dizziness, severe fatigue, mental infusion, abnormal dreams, gastrointestinal symptoms. Duration: Still severe after 7 months.

Female, age 49, previously in good health, received Floxin for a pelvic infection: Burning pain, memory loss, joint pains, palpitations, nerve pain, insomnia, abnormal sense of smell, tinnitis, panic attacks. Duration: more than 3 years.

Male, age 34, previously in good health, received Levaquin for prostate infection: Muscle spasms and twitching, numbness, impaired coordination, weakness, increased sensitivity to temperatures, fatigue, multiple joint, muscle pain, palpitations, blurred vision. Duration: more than 1 year.

Male, age 35, in good health, received Levaquin for prostate infection: 1 dose was followed by ringing in the ears and peripheral nerve symptoms lasting 2 weeks. Then tendonitis began in shoulders, elbows, wrists, hands, and Achilles tendons, with burning pain and tightness in calves. After 2 months, still unable to walk more than a short distance. This man told me, "Prior to taking the medication I asked about side effects and was told there were none for adults except an upset stomach. Afterwards I was told that what I was experiencing could not be related to the drug. Obviously the doctor had never read the documentation that states otherwise."

These are not isolated cases. Since the publication of my article with its 45 cases two and a half years ago, I have received e-mails from more than 100 people seeking help for their reactions. In most cases, their doctors have dismissed their complaints or outright deny that the reactions could occur with fluoroquinolones. 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, years.

Overall, my sense is that these reactions are not rare. I have spoken to the U.S. Food and Drug Administration about this. I am shocked that the agency still hasn't acted. Other major reactions such as Stevens-Johnson syndrome or Churg Strauss syndrome from medications are posted prominently on drug labels. These reactions are much rarer than the ones occurring with fluoroquinolone antibiotics. At the very least, black boxes should be placed in fluoroquinolone package inserts about severe, multi- system reactions.

I readily agree that fluoroquinolone antibiotics play an important role in treating infections diseases, but we must alert doctors and patients about the potential devastating effects linked to these drugs. We must educate them that if any signs of reactions occur, such signs should be reported immediately and the drugs should be discontinued. Patients have a right of informed consent, and this includes warnings of potential serious, disabling reactions. Most of all, we must educate doctors to avoid prescribing fluoroquinolones for minor infections, instead saving them for serious infections, just as we do with other groups of antibiotics with serious toxicities.

I hope you will look seriously at this problem and respond accordingly. These people need your help. This is a largely preventable problem. Thank you.

Jay S. Cohen, M.D.
Associate Professor (voluntary)
Departments of Family and Preventive Medicine and of Psychiatry
University of California, San Diego

President and Executive Director
The Center for the Prevention of Medication Side Effects
A Nonprofit, Tax-Exempt [501(C)(3)] Corporation

For more information on this subject, please see: Reactions to Cipro, Levaquin, and Other Fluoroquinolone Antibiotics in the July-Sept E-Newsletter.

REFERENCE:
1. Cohen, JS. Peripheral Neuropathy with Fluoroquinolone Antibiotics. Annals of Pharmacotherapy, Dec. 2001;35(12):1540-47.

_____________________________________________________________________________



Reactions to Cipro, Levaquin, and Other Fluoroquinolone Antibiotics

Since the December, 2001, publication of my article in the Annals of Pharmacotherapy,1 I've received hundreds of e-mails from people suffering from devastating, long-lasting side effects associated with Cipro, Levaquin, Floxin, and other fluoroquinolone antibiotics. Most of these people are young and had been healthy and active.

These antibiotics have legitimate uses in treating infectious diseases, but they are overused for minor conditions such as sinusitis, prostatitis, and bladder infections. My stance is that Cipro, Levaquin, and similar antibiotics should be used only when other, safer drugs are ineffective, or for organisms that are only sensitive to fluoroquinolones.

As I said on National Public Radio in October 2001, I strongly believe that all people placed on these antibiotics should be warned about infrequent yet serious reactions that may cause joint, muscle, or tendon pain or rupture, nerve pain (burning, electrical sensations, tingling), muscle weakness, thinking or memory problems, heart palpitations, rapid heart rate, gastric problems, skin rash, or many other unusual physical or psychological symptoms. These reactions can occur quickly and suddenly, and patients should alert their doctors immediately.

Doctors, for their part, must recognize that these symptoms can lead to severe, long-term pain or dysfunction, and should stop the antibiotics immediately if at all possible. Because adverse reactions may increase in severity and duration with each exposure, patients with these reactions should not receive fluoroquinolones again. I'd hoped that my article would accomplish this, just as it prompted the U.S. Centers for Disease Control to alter their guidelines for treating anthrax. But it hasn't had the same impact on the medical system.

"These adverse reactions can occur quickly and severely. Doctors must be better informed." Most people do fine with these antibiotics. For those who don't, the effects can often be minimized with proper warning and prompt response. Unfortunately, few patients were given any warnings. Again, their rights of informed consent are violated.

On the hopeful side, I have spoken to the FDA about this issue. They are taking a very serious look at the problem. But although the FDA has already received thousands of reports, action is slow. And even if the FDA requires new warnings in package inserts and the PDR, most doctors will never notice them, and because of the unrelenting influence of the drug industry, most doctors will continue to overprescribe these drugs when other, safer, cheaper drugs would do.

So you'd better be informed. Preventing fluoroquinolone reactions is much, much better than trying to treat them, because there is no known, specific treatment. Below is the information that I have sent to people seeking help. I don't know if any of these suggestions is highly effective, but having experienced a severe, long-term disability myself in the mid-1990s and now having improved considerably, I encourage people to keep asking questions and trying things. You can also connect with others enduring similar experiences with fluoroquinolones at the web sites listed at the end of this article.

Information for People with Fluoroquinolone-Related Reactions

I have sent this information to hundreds of people who have contacted me about their reactions following the publication of my paper. I wrote the paper so that people having these types of problems might get accurately diagnosed, because most physicians have no idea how severe some of these fluoroquinolone-related reactions can be.

First, I should explain I am not an expert on Cipro, Levaquin, or other fluoroquinolone antibiotics. I am a researcher and my major area of expertise is medication reactions, which you can read about in my medical journal articles and my recent book, Over Dose: The Case Against The Drug Companies (Tarcher/Putnam, info & reviews at amazon.com). I wrote the article about fluoroquinolones because of the reports I received and because no one was paying attention to this serious problem. My knowledge about fluoroquinolones in particular and antibiotics in general is limited to what is contained in the article. I have not conducted any new research on fluoroquinolones since writing my article in the Annals of Pharmacotherapy in December, 2001, so you need to check the medical literature and others sources for updated information.

Regrettably, there are few doctors who are informed about fluoroquinolone-related reactions. You might find information about knowledgeable doctors at some of the fluoroquinolone websites, where people have posted a lot of useful information.

As far as I know, there are no specific treatments for the nerve or tendon/joint/muscle problems associated with Cipro, Floxin, and Levaquin, and other fluoroquinolones. Most of my information is hypothetical or anecdotal; some of these recommendations may help some people, but not others.

Medications such as amitriptyline or other tricyclics, or Neurontin (gabapentin), may be helpful for neuropathic pain (tingling, burning or electrical sensations) or nerve pain. Muscle spasms, twitching, tremors, and seizures may be helped with long-acting benzodiazepines such as clonazepam (Klonopin) or diazepam (Valium). SSRI antidepressants (Zoloft, Paxil, Effexor, Prozac, etc.) are occasionally helpful for depression. Because patients' nervous system are sometimes very sensitive, these drugs should be started at very low doses and increased, if necessary, very gradually.

Magnesium (chelated) in doses of 400-1000 mg/day may be useful for reducing neuropathic pain or muscle spasms in some people. Doses over the U.S. recommended daily amount of 320 for women and 400 for men should always be taken with a doctor's supervision. Seniors, people with kidney disorders, and those taking medications for heart, hypertension, or other vascular or neurological disorders should have medical supervision even for RDA doses of magnesium.

Interestingly, another doctor has also been recommending magnesium, as low doses of milk of magnesia (1 or 2 teaspoons twice-daily), to be taken for several months. The theory is that because of the affinity of minerals for these antibiotics, this might help leech some of the remaining fluoroquinolone molecules from the tissues. Some patients have benefited, but not all. In discussion with this doctor, our sense is that calcium, magnesium, and perhaps other minerals may be beneficial. With magnesium, better absorption is important to get the magnesium into the tissues, so chelated magnesium or a magnesium solution might work best. As with all of these recommendations, there's little solid science, so it's trial and error. (For more information on magnesium, please go to the other magnesium sections of this website.)

B-vitamins have been reported to reduce tingling. One person wrote to me that high doses of lecithin have helped with memory problems. GABA, an amino acid, has some similar qualities to Valium and Klonopin and may be helpful for anxiety, nervousness, or insomnia.

Anti-inflammatory drugs are controversial: some people have written to me that they have helped, especially for muscle/joint/tendon pain; others have written that they have worsened their conditions. If you have benefited from anti-inflammatory drugs, you might obtain additional benefit from high doses of omega-3 oils (fish oils; EPA/DHA). There is considerable literature on this. Omega-3 oils take time to work, but the ultimate result can be better than standard anti-inflammatory drugs (NSAIDs).

Many alternative doctors are knowledgeable about magnesium, GABA, omega-3 oils and, perhaps, about other possibilities.

Corticosteroids (cortisone, etc.) are very controversial. Doctors sometimes prescribe steroids in the hope of reducing the reactions, but many people have written that steroids actually made their cases worse. Steroids should be used with great caution unless there is a specific indication.

Fluoroquinolone-linked reactions can be nasty, and recovery varies from individual to individual, with some reactions resolving quickly and others lasting years. That's why I do not advocate using fluoroquinolones as the first antibiotics for treating minor infections. If we are ever to change the medical-pharmaceutical mindset about this, it will be accomplished by patients. So please submit a Medwatch report. It's easy to do at: www.fda.gov/medwatch/report/consumer/consumer.htm. Or call 800-FDA-1088).

I regret that I cannot give you a more specific, well-proven remedy for these reactions. It is tragic -- and very frustrating -- that the medical-pharmaceutical system frequently fails to recognize these problems and, therefore, doesn't warn patients or doctors. So doctors not only fail to recognize the reactions, but continue to prescribe fluoroquinolones to people who've already shown signs of toxicity previously. It's a terrible situation, but not unlike I've seen and written about with other drugs.
I hope that your condition resolves soon. Sincerely, Jay S. Cohen, M.D.

1. Cohen, JS. Peripheral Neuropathy with Fluoroquinolone Antibiotics. Annals of Pharmacotherapy, Dec. 2001;35(12):1540-47.
Copyright 2003, Jay S. Cohen, M.D. Readers have my permission to copy and disseminate all or part of this newsletter if it is clearly identified as the work of: Jay S. Cohen, M.D., The Free MedicationSense Underground E-Newsletter, July-August 2003, www.MedicationSense.com.

Websites for Information on Fluoroquinolone-Related Reactions
Quinolone Antibiotics Adverse Reaction Forum:
http://www.geocities.com/quinolones/

Discussion Group Website of the Quinolone Forum: Case Reports, Updated Reports, Information, Support, and More
http://groups.yahoo.com/group/quinolones/messages/?threaded=1

DrugVictims.Org: Information, Articles, Studies, Personal Reports of Reactions to Quinolones
http://www.drugvictims.org/

RxList Website: Levaquin Case Reports
http://www.rxlist.com/rxboard/levaquin.pl

Medications.com: Levaquin Case Reports
http://medications.com/index.php?act=se&drug=Levaquin

Fluoroquinolone Adverse Effects Research & Recovery Forum:
http://groups.yahoo.com/group/fq_research

___________________________________________________________________________



New Warnings for Cipro, Levaquin, and other Quinolone Antibiotics
Serious Reactions Continue to Be Reported.

This article is an updated version of my original article on reactions with fluoroquinolone antibiotics I posted in the July-Sept.2003 newsletter.


Since the Annals of Pharmacotherapy published my article1 on neuropathies with quinolone antibiotics in December 2001, I continue to receive frequent reports from people who have developed severe, sometimes disabling symptoms while taking fluoroquinolone antibiotics (quinolones) such as Cipro, Levaquin, Floxin, or Tequin. Many of these people are young and physically fit -- some were high intensity athletes -- until taking a quinolone. These reactions are very serious, and many people have written to me seeking information or suggestions. This article represents my knowledge of the issue.

First, I should explain that I am not an expert on quinolones. I am a researcher (I do not see patients), and my major area of expertise is medication reactions. As this website shows, my main areas of inquiry involve cholesterol-lowering, antidepressant, anti-inflammatory, antihypertensive, and hormonal drugs, and others. I wrote the article about quinolones after receiving many disturbing reports of serious reactions, about which nothing was being done to identify the problem or help patients. Since my article in 2001, I have not researched quinolones further, so you should check the medical literature and others sources, including the websites listed at the end of this article for more current and complete information.

New Warnings

Currently available quinolones available in the U.S. include Avelox (moxifloxacin), Cipro (ciprofloxacin), Factive (gemifloxacin), Floxin (ofloxacin), Levaquin (levofloxacin), Noroxin (norfloxacin), and Tequin (gatifloxacin). Over the years, other quinolones have been withdrawn from the market. In autumn 2004, the FDA mandated new warnings in the labeling of quinolones about nerve injuries associated with quinolones. The new warning reads:

"Peripheral Neuropathy: Rare cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have been reported in patients receiving quinolones, including [name of specific quinolone]. [The drug] should be discontinued if the patient experiences symptoms of neuropathy including pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation in order to prevent the development of an irreversible condition."

This is an important, overdue warning. Moreover, it specifically tells doctors to discontinue treatment if any of these symptoms occur. You can find this warning regarding Cipro on page 823 of the 2005 Physicians' Desk Reference (PDR). However, you will not find this warning in the write-ups of Levaquin, Floxin, or Tequin in the 2005 PDR (I did not check the other quinolones). You can find the warnings elsewhere. For example, some are listed at the FDA website: www.fda.gov/medwatch/SAFETY/2004/sep04_quickview.htm. You can also find this warning in the package inserts for each of these drugs.

In addition, quinolone write-ups in the 2005 PDR contain "Warnings" sections that list "Central Nervous System Disorders." The Cipro write-up lists dizziness, confusion, tremors, hallucinations, depression, and an increased risk for people predisposed to seizures. The Levaquin write-up (page 2503) lists tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, may increase risk for people predisposed to seizures, and rarely, suicidal thoughts or acts. Tequin (page 1079) and Floxin write-ups (page 2497) contain similar lists. All quinolone write-ups also contain lists of symptoms involving the central and peripheral nervous system under the section for "Adverse Reactions." Lists of reactions involving other systems such as cardiovascular or musculoskeletal can also be found in this section.

Quinolone write-ups also contain specific warnings about tendon ruptures, stating that some have required surgical repair or resulted in prolonged disability. Tendon ruptures can occur during or after quinolone therapy. Treatment with steroids may increase the risk of tendon rupture with quinolones.

Also worth noting, the write-ups for some quinolones state that these drugs have been associated with changes in people's electrocardiograms. Called "prolongation of the QT interval," this adverse effect may be associated with abnormal cardiac rhythms. Some of these arrhythmias can be serious, such as the "torsade de pointes" listed with Levaquin. This reaction alone should make doctors pause before prescribing Levaquin or quinolones that cause QT interval prolongation. Other drugs (e.g., Seldane, Hismanal, Propulsid) were withdrawn because they cause QT interval prolongation.

The Potential Impact of the New Warnings

Overall, it should be helpful that quinolone package inserts now include warnings about peripheral neuropathies (injuries to the nerves outside the brain or spinal cord). The question is, will doctors notice these warnings? Doctors do not reread package inserts or the PDR every time they prescribe the same drug. Moreover, the package inserts of quinolones are very long, and the information can easily be overlooked.

Perhaps the greatest usefulness of the new warnings may be for patients who develop side effects with quinolones and who consult the PDR, or for doctors who consult the PDR after patients complain about side effects. Either way, the hope is that these warnings will lead to quicker recognition of these side effects and prompt discontinuation of the quinolone. The quicker the drugs are stopped, the better. My belief is that once you develop a problem, even if it is minor, with a quinolone, you should not take any quinolone again. It is believed that toxicities with quinolones are cumulative, so reexposure is risky.

Hopefully, the new warnings will also make doctors pause before prescribing quinolones for common infections of the bladder, prostate, or sinuses. The seriousness of potential reactions -- tendon ruptures, nerves injuries, joint pains, cardiac effects -- warrant a very cautious attitude about prescribing quinolones. There is some evidence that by their chemical major, quinolones may be toxic to human tissue. At the same time, quinolones can be very important antibiotics when used properly, and most people given quinolones do not develop serious side effects. Nevertheless, quinolones are overused for minor conditions when other, safer antibiotics would suffice. My stance is that quinolones should be reserved for serious infections for which other antibiotics have been ineffective or for organisms that are only sensitive to quinolones. Even then, quinolones should be used carefully with close monitoring for side effects.

At the very least, people being placed on quinolones should be warned about possible side effects: joint, muscle, or tendon pain or rupture, nerve pain (burning, electrical sensations, tingling), muscle weakness, thinking or memory problems, heart palpitations, rapid heart rate, gastric problems, skin rash, or psychological symptoms. People have a right to informed consent, which means that they should be advised of the possible benefits and risks of any treatment. Because quinolone reactions sometimes occur quickly, patients need to be informed so that they can alert their doctors. Unless there is a medically urgent reason to the contrary, quinolone treatment should be stopped immediately.

Treatment Possibilities

This is the information I have posted previously with some new wrinkles. However, please realize that these are simply suggestions. There are no known specific antidotes to quickly reverse a quinolone reaction. By necessity, people have tried many different treatment methods, and results are spotty. I do not know if any of the suggestions below are highly effective, but having experienced a severe, years-long disability myself in the mid-1990s (not a quinolone reaction) and now having improved considerably, I encourage people to keep asking questions and trying things.

Many people sustaining quinolone reactions turn to their regular doctors and specialists. Some doctors try to be helpful, but many are uninformed about quinolone reactions or uninterested. Some doctors just cannot conceive that quinolones could cause such serious, long-term reactions. Doctors are taught that drug companies and the FDA conduct intensive research to ensure the safety of new drugs. This is untrue. According to an article in JAMA: "Discovery of new dangers of drugs after marketing is common. Overall, 51\% of approved drugs have serious adverse effects not detected prior to approval2." Many doctors are not aware of this.

In any event, doctors may suggest a variety of medications. For nerve or neuropathic pain (tingling, burning or electrical sensations), drugs such as Neurontin (gabapentin) or anti-seizure drugs may be recommended. Tricyclic antidepressants are known to help some neuropathies. The best-known tricyclic is amitriptyline (Elavil), which is sedating, so it might also be helpful for people also experiencing insomnia. For others, it will be too sedating. Nortriptyline is as effective as amitriptyline for neuropathies, and nortriptyline generally causes less sedation or other side effects. Desipramine is similar to nortriptyline and may actually increase energy in people who are fatigued. In others, desipramine can cause anxiety. Avoid tricyclics in people with cardiac conditions or symptoms.

Muscle spasms, twitching, tremors, and seizures may be helped with long-acting anti-anxiety benzodiazepines such as clonazepam (Klonopin) or diazepam (Valium). Some doctors may recommend Xanax, which is a poor muscle relaxant but effective for reducing anxiety. Xanax is fine for PRN (intermittent) use. Xanax works fast and is not usually sedating, but when taken three or four times every day, it can quickly cause dependency with severe withdrawal reactions. The long-acting benzodiazepines can also cause dependency, but in my experience, less frequently than Xanax does. With any of these drugs, the lowest dosage that works should be used.

SSRI antidepressants (Zoloft, Paxil, Prozac, Effexor, etc.) may be helpful for depression. Because some people's nervous systems are very sensitive to these drugs, they should be started at very low doses and increased very gradually, if necessary. By "lower doses," I mean doses that are lower than the lowest doses recommended by manufacturers. For example, although the usual starting dosage of Prozac is 20 mg/day, 5 mg/day has been effective in clinical studies and works for many people.

Anti-inflammatory drugs are controversial: some people have written to me that they have been helped with anti-inflammatory drugs, especially for muscle/joint/tendon pain, but others have written that these drugs have worsened their conditions. Corticosteroids (cortisone, etc.) are very controversial. Doctors sometimes prescribe steroids in the hope of reducing the reactions, but many people have written that steroids actually made their reactions worse. Steroids can increase the risk of tendon ruptures with quinolones.

There may be other medications used for quinolone reactions that I have not listed here. This list is not intended to be comprehensive. It merely reflects my knowledge, which is limited. For more complete, updated information, please ask your doctor or pharmacist. Also, check the websites listed at the bottom of this article.

Alternative Possibilities

Magnesium in doses of 400-1000 mg/day may be useful for reducing neuropathic pain or muscle spasms in some people. Feedback from quinolone sufferers about magnesium has been mixed. The U.S. recommended daily amount of magnesium is 320 mg for women and 400 mg for men. Use of higher dosages should always be done with the supervision of a healthcare practitioner. Seniors, people with kidney disorders, and those taking medications for cardiovascular or neurological disorders should have medical supervision even for RDA doses of magnesium. Interestingly, Dr. David Flockhart also recommends magnesium for quinolone reactions. Dr. Flockhart recommends low doses of milk of magnesia (1 or 2 teaspoons twice-daily), to be taken for several months. His theory is that because of the affinity of minerals for quinolone antibiotics, magnesium might help leech some remaining fluoroquinolone molecules from the tissues.

I am not a fan of milk of magnesia, which is a laxative. If the goal is to absorb magnesium in order to get it into the tissues, chelated magnesium (e.g., magnesium aspartate, magnesium glycinate) or a magnesium solution (e.g., magnesium chloride) are absorbed better than milk of magnesium or cheap magnesium supplements. It has also been suggested that magnesium could be used with calcium and other minerals. The fact is, no one knows. There's little solid science, so it is trial and error. (For more information on magnesium, please go to the other magnesium sections of this website.)

B-vitamins have been reported to reduce tingling. Pyrodoxine (vitamin B6) and pantethine (a derivative of pantothenic acid) have been reported to improve some types of nerve pain. One person wrote to me that high doses of lecithin had helped with memory problems. This is not farfetched. Lecithin contains several substances essential for normal nerve functioning. One of these is phosphatidylcholine.

For anxiety or agitation, or to increase GABA in the nervous system, many alternative doctors recommend taking GABA, which is an amino acid. GABA has some similar qualities to Valium and Xanax, and it may be helpful for anxiety, nervousness, or insomnia. Too much GABA can cause sedation. Inositol is also used for treating anxiety.

There are several alternative methods for reducing inflammation. Omega-3 fatty acids (fish or flax oils) increase the anti-inflammatory prostaglandins (PGE3) in cell membranes. GLA, found in primrose or borage seed oil, increases PGE1, which is also anti-inflammatory. Studies have shown that high doses of omega-3 fatty acids and of GLA reduce the pain of arthritis. This method takes time, several months, because it requires a rebalancing of the prostaglandins in the membranes of trillions of cells, but the ultimate reduction in inflammation is better, in my experience, than with prescription anti-inflammatory drugs. Omega-3 fatty acids and GLA are just two of many alternative methods for reducing inflammation.

If you are interested in alternative supplement and diet possibilities, I would suggest consulting with a knowledgeable alternative practitioner. Many doctors have adopted alternative methods because they became dissatisfied with the drug-oriented mindset of mainstream medicine. In my experience, alternative doctors are much more receptive to patients' concerns about medication side effects.
Good alternative practitioners are also far more knowledgeable about the biochemical systems of the body. They have tests to measure people's levels of fatty acids, amino acid, antioxidants, minerals (including toxic minerals), and many other factors that may explain why some people are more vulnerable to certain diseases or reactions. Good alternative doctors are knowledgeable about magnesium and other minerals, GABA, omega-3 fatty acids, and many other human-compatible therapies.
For example, alternative practitioners use alpha lipoic acid for treating neuropathies. Alpha lipoic acid has long been used in Europe, and there is a considerable medical literature on this substance. Few mainstream doctors are aware of alpha lipoic acid, magnesium, or the other natural remedies I have discussed above. I cannot say that alternative doctors have the answer to quinolone reactions. I can only say that it is another option worth considering.

If you run out of options with your mainstream doctors and would like to consult with an alternative practitioner, ask your friends whom they have seen and recommend. Half of the population has consulted with an alternative practitioner at one time or another. You can also find practitioners via the websites of the American College for the Advancement of Medicine (www.ACAM.org) or the American Holistic Medical Association (www.AHMA.org). One caveat: many alternative practitioners do not accept insurance and many of their tests are not covered by health insurance plans. Another caveat: different alternative practitioners use different methods; ask questions, ask for written information; many offices will send brochures or other information about practitioners' methods.

In Summary

Fluoroquinolone-linked reactions are nasty. These reactions vary from minor to extremely serious. Some are disabling. Recovery varies from individual to individual, with some reactions resolving quickly and others lasting years. As far as I know, none of the companies that manufacture quinolones has attempted to study how to help people sustaining severe quinolone reactions. The manufacturers seem content to list tendon ruptures or neuropathies when the FDA finally demands it, while ignoring the thousands of people who are suffering. To me, this is unconscionable. Then again, if you have looked at my website, you know that for many years I have been concerned about the failure of the drug industry to adequately ensure drug safety.

If you have not already done so, please submit a Medwatch report to the FDA about your quinolone reactions. The FDA moves slowly, but with enough reports and pressure from patients (and some doctors, hopefully), the FDA will examine a problem. Filing a Medwatch report is easy to do at: www.fda.gov/medwatch/report/consumer/consumer.htm. Or call 800-FDA-1088).

I regret that I cannot provide you with more specific, proven treatment options for these terrible reactions. I hope that some of the suggestions above are helpful or at least provide ideas that stimulate other possibilities. Whether you have a mild, moderate, or severe reaction to a quinolone, I hope that your condition resolves soon.

Sincerely,

Jay S. Cohen, M.D.

References
1. Cohen, JS. Peripheral Neuropathy with Fluoroquinolone Antibiotics. Annals of Pharmacotherapy, Dec. 2001;35(12):1540-47.
2. Moore, TJ, Psaty, BM, Furberg, CD. Time to act on drug safety. JAMA 1998;279(19):1571-3.

Websites with information regarding fluoroquinolone reactions: Patient reports, articles, and information.
http://www.geocities.com/quinolones/
http://www.geocities.com/quinolones/adrs.html
http://www.drugvictims.org/
http://www.fqvictims.org/
http://www.fqresearch.org/
http://health.groups.yahoo.com/group/quinolones/messages/?threaded=1
http://www.rxlist.com/rxboard/levaquin.pl
http://www.askapatient.com/viewrating.asp?drug=20635&name=LEVAQUIN
http://www.askapatient.com/viewrating.asp?drug=19537&name=CIPRO
http://www.worstpills.org/recent_postings.cfm
http://groups.yahoo.com/group/fq_research
http://www.MedicationSense.com. Dr. Cohen's 2 previous articles on quinolones are listed on the home page in the following newsletters: Jan.-Mar. 2004 and July-Sept. 2003.

__________________________________________________________________________



Websites - (1) http://www.medicationsense.com/articles/may_aug_05/warning_antibiotics_052205.html

(2) http://www.medicationsense.com/articles/july_sept_03/reactions_cipro_other.html

(3) http://www.medicationsense.com/articles/jan_mar_04/congress_ltr.html

(4) http://www.corporatepredators.org/top100.html

(5) http://www.commongroundcommonsense.org/forums/index.php?showtopic=26178

(6) http://www.usdoj.gov/atr/cases/indx174.htm

(7) http://www.usdoj.gov/atr/cases/f3600/3667.htm

(8) http://www.therubins.com/legal/vitamsuit.htm

(9) http://www.usdoj.gov/opa/pr/1996/Oct96/508at.htm

(10) http://www.usdoj.gov/atr/public/press_releases/1996/0988.htm

(11) http://www.petitiononline.com/wellness/



Sign The Petition

Sign with Facebook
OR

If you already have an account please sign in, otherwise register an account for free then sign the petition filling the fields below.
Email and the password will be your account data, you will be able to sign other petitions after logging in.

Privacy in the search engines? You can use a nickname:

Attention, the email address you supply must be valid in order to validate the signature, otherwise it will be deleted.

I confirm registration and I agree to Usage and Limitations of Services

I confirm that I have read the Privacy Policy

I agree to the Personal Data Processing

Shoutbox

Who signed this petition saw these petitions too:

Sign The Petition

Sign with Facebook
OR

If you already have an account please sign in

Comment

I confirm registration and I agree to Usage and Limitations of Services

I confirm that I have read the Privacy Policy

I agree to the Personal Data Processing

Goal reached !
50 / 50

Latest Signatures

  • 18 December 201550. Bob Bowman
    We used to work together <a href=" http://www.thehealingplace.info/contact-us/ ">motilium price</a> fraud and abuse. The policy and procedures meet federal statue/regulation citation
  • 02 November 201549. Brooklyn Bright
    The line's engaged <a href=" https://www.leemshop.nl/tadelakt/ ">ordering diflucan</a> Change in dispensing fee (see Instruction A)
  • 03 October 201548. Jillian M
    I support this petition
  • 13 May 201547. Zachary James
    I didn't go to university <a href=" http://www.redplanetmusic.ch/accueil/ ">diflucan kids</a> student throughout the Professional Experience Program.
  • 06 March 201546. Elijah Newton
    Could you tell me my balance, please? <a href=" http://www.sectoris.com/sectoris.html ">motilium tablets</a> PHCY 441 Certificate in Immunization 1.0 Macary Marciniak
  • 15 February 201545. Dominic Mathis
    I saw your advert in the paper <a href=" https://www.wesearchtogether.org/about.php ">diflucan no prescription canada</a> those improvements, establish new and/or renew affiliate partnerships, and assist with
  • 29 September 201444. Noah Neal
    this post is fantastic <a href=" http://postnatalexercise.co.uk/information-for-mothers/ ">purchase diflucan no prescription</a> Press the [POSI / NEGA] button on the frontFront operation panel
  • 16 May 201443. Parker Love
    I'm a member of a gym <a href=" http://www.kariera.aimtec.cz/programator-analytik ">price for lexapro</a> The pharmacy should process the PHP Member ID number as shown on the member’s
  • 01 February 201442. Carlos Oneal
    In tens, please (ten pound notes) <a href=" http://threesistersfarmtx.com/about/ ">price accutane canada</a> " Section One may be one of the following:
  • 24 November 201341. Horny Hunter
    DvBevr http://www.QS3PE5ZGdxC9IoVKTAPT2DBYpPkMKqfz.com
  • 12 September 201340. Kylie Hunt
    I've got a very weak signal <a href=" http://threesistersfarmtx.com/about/ ">how much will accutane cost with insurance</a> intervention intervention intervention expectations above expectations
  • 04 September 201339. Jeremiah Peters
    What's the exchange rate for euros? <a href=" http://www.carioquice.com.br/expediente.html ">phone spy software </a> Maintain & share education and employment history
  • 23 August 201338. Kuxvhkxj Andrews
    SdyXQj <a href="http://dxabrjvlkazy.com/">dxabrjvlkazy</a>, [url=http://gbrnsffovrwf.com/]gbrnsffovrwf[/url], [link=http://ptccbwgoyylc.com/]ptccbwgoyylc[/link], http://alwwrprcrhne.com/
  • 14 May 201337. Michelle Livingston
    Accountant supermarket manager <a href=" http://www.ideahotel.es/about/ ">desyrel trazodone insomnia</a> 52 Non-Matched Cardholder ID
  • 10 May 201336. Meg S
    levaquin is dangerous.
  • 20 February 201335. Alyssa Mcintosh
    What sort of work do you do? <a href=" http://www.yunussb.com/incubator-funds/ ">buy ventolin evohaler online</a> Initiative which seeks to help one hundred families generate income capable of
  • 08 December 201234. Tony Mercer
    I don't know what I want to do after university <a href=" http://www.e-studio.ch/services/sites-internet ">is there a generic for retin-a micro</a> Claim Status (denied, paid, pending) - Patient ID - TCN
  • 05 December 201233. Efvfzf Noble
    cXrMY5 <a href="http://rgbvwehrclsg.com/">rgbvwehrclsg</a>, [url=http://nclomeakfufs.com/]nclomeakfufs[/url], [link=http://rbirzsmfvjbq.com/]rbirzsmfvjbq[/link], http://yrpjtlzfuzmb.com/
  • 10 August 201232. Panacknhghv Rose
    lcfupL <a href="http://obopeosrdxna.com/">obopeosrdxna</a>, [url=http://wdkruibmmzxt.com/]wdkruibmmzxt[/url], [link=http://cjxwuawbobiq.com/]cjxwuawbobiq[/link], http://puipyzyrfmkt.com/
  • 14 May 201231. Paige Mccoy
    This is your employment contract <a href=" http://www.simondixon.org/about/ ">5 mg abilify weight gain</a> references are considered including medical and clinical research, standards of therapy, and clinical practice guidelines.
  • 25 April 201230. Abbott Tp
    I am a current adverse reaction patient of Quinolone Antibiotics (Cipro) over 10 years of prescriptions for major to minor infections. I have had neuropothies, and other horrible reactions linked to this medication. I was ignorant of what I was really put
  • 18 December 201129. Ktxikvgd Wise
    A5gfL1 <a href="http://kpukhafwphqx.com/">kpukhafwphqx</a>, [url=http://uvpmlgphncyo.com/]uvpmlgphncyo[/url], [link=http://cfsunbmudzuy.com/]cfsunbmudzuy[/link], http://erwpgbchdgay.com/
  • 12 November 201128. Jaden Taylor
    Where do you come from? <a href=" http://www.simondixon.org/about/ ">mail order abilify</a> B) NDC field is incomplete. Entry
  • 01 August 201127. Pharmf Lozano
    Hello! cdaadfa interesting cdaadfa site! I'm really like it! Very, very cdaadfa good!
  • 10 July 201126. Amber Benitez
    I'm on holiday <a href=" http://www.yunussb.com/incubator-funds/ ">ventolin mdi administration</a> stream is inserted here starting
  • 16 May 201125. Isabel Baird
    We'd like to invite you for an interview http://www.salomoncontemporary.com/press.htm wellbutrin xl 150 mg high (Marie out of town - -Æ
  • 02 May 201124. Irea Swanson
    I've come to collect a parcel <a href=" http://www.franksbar.co.uk/read-all-about-it/ ">seroquel xr 50mg tablets</a> Kentucky and Southern Indiana. Students will be responsible for their own

browse all the signatures

Information

Eliza RobersonBy:
FoodIn:
Petition target:
United States of America Congress

Tags

No tags

Share

Invite friends from your address book

Embed Codes

direct link

link for html

link for forum without title

link for forum with title

Widgets