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Author: Korean quinolones such as ciprofloxacin, levofloxacin, moxifloxacin, etc.
, are a class of synthetic broad-spectrum antibacterial drugs
.
It has the characteristics of rapid sterilization, strong tissue penetration, high oral bioavailability, long elimination half-life, and no cross-resistance with other antibacterial drugs.
It can be clinically used for respiratory system infections, intestinal infections, urinary system infections, and skin and soft tissue infections.
, Bone and joint infections,
etc.
1.
Cardiovascular reactions Quinolones such as levofloxacin, moxifloxacin, gatifloxacin, and sparfloxacin can cause ventricular arrhythmia, prolongation of QT interval, and occasionally develop to severe arrhythmia such as torsades de pointes (TdP).
.
Original QT interval prolongation, female, elderly, congestive heart failure, concomitant use of class IA and III antiarrhythmic drugs, combined use of other QT interval prolonging drugs, combined use of CYP450 inhibitors, hypokalemia, Hypomagnesemia and renal insufficiency are risk factors for QT interval prolongation
.
Use with caution in patients with prolonged QT interval
.
On December 20, 2018, the FDA issued a safety alert stating that fluoroquinolones may increase the risk of aortic dissection and rupture of aortic aneurysms, and their use is associated with an increased risk of aortic dissection or rupture of aortic aneurysms, which may lead to Bleeding or even death occurs
.
Fluoroquinolones should not be used in people at increased risk, such as those with blockages or aneurysms of the aorta or other blood vessels, people with high blood pressure, certain genetic disorders involving blood vessels, and the elderly, unless there are no other treatment options
.
Second, fluoroquinolones should not be given to people with aneurysms or a risk factor, including those with peripheral atherosclerotic vascular disease, hypertension, Marfan syndrome and Ehlers-Danlos syndrome, and the elderly
.
Drug interactions: Combined use with macrolides, class IA or class III antiarrhythmic drugs, and cisapride can increase the risk of QT interval prolongation, which can lead to fatal arrhythmias in severe cases.
Avoid combined use as much as possible.
.
Combination of sparfloxacin with phenothiazine antipsychotics, tricyclic antidepressants, etc.
may increase the risk of arrhythmia, and it is prohibited to use them together
.
Second nervous system reactions such as levofloxacin, ciprofloxacin, enoxacin, etc.
, manifested as dizziness (prone to the elderly), headache, insomnia, anxiety, disturbance of consciousness or mental disorders (high-risk groups are the same with NSAIDs or CYP450 enzyme inhibition) Drugs), convulsions (high-risk groups include history of epilepsy, brain trauma, hypoxemia, combined use of NSAIDs or theophylline),
etc.
Quinolones can inhibit the effect of gamma-aminobutyric acid (GABA), which can induce epilepsy, and should be used with caution in patients with a history of epilepsy
.
In addition, patients with renal insufficiency who use quinolones mainly excreted by the kidneys without reducing their doses are prone to nervous system reactions
.
Others include convulsions, increased intracranial pressure (including pseudotumors), nightmares, tremors, and hallucinations
.
Drug Interactions: Combined use with NSAIDs (except aspirin) can increase the incidence of adverse events in the central nervous system, manifested as insomnia, nervousness and convulsions.
Avoid combined use as much as possible
.
For example, third-generation quinolones such as lomefloxacin and enoxacin are used in combination with flurbiprofen axetil, the latter can enhance the former's inhibitory effect on the release of gamma-aminobutyric acid, which may cause convulsions; the combination of enoxacin and ibuprofen , there is a risk of convulsions
.
In addition, fluoroquinolones have neuromuscular blocking activity, and may aggravate the symptoms of myasthenia gravis in patients with myasthenia gravis.
The use of fluoroquinolones in patients with myasthenia gravis may cause death or require assisted breathing
.
Furthermore, peripheral neuropathy develops soon after fluoroquinolones use, usually within a few days, and in some patients symptoms persist for more than a year despite discontinuation
.
It did not appear to be associated with time of treatment or age, and the incidence was unclear
.
Stop if symptoms of peripheral neuropathy such as pain, burning, tingling, numbness, and/or weakness or other sensory changes such as light touch, pain, temperature, position, and vibration occur.
Substitute a fluoroquinolone with another non-fluoroquinolone antibacterial drug
.
Unless the benefits of continuing fluoroquinolone therapy outweigh the risks
.
Dysglycemia (such as symptomatic hyperglycemia and hypoglycemia) caused by the use of fluoroquinolones in the three endocrine systems may be a similar reaction, which mostly occurs in diabetic patients who take oral hypoglycemic drugs or insulin at the same time, and hypoglycemia occurs in different fluoroquinolones.
The risk will vary, with moxifloxacin being the highest risk
.
If nausea, vomiting, palpitations, sweating, paleness, hunger, limb tremors, transient syncope, etc.
occur, consider the possibility of blood sugar disorders
.
Such as hypoglycemia reaction levofloxacin, moxifloxacin, gatifloxacin, etc.
, high-risk groups are combined oral hypoglycemic drugs, hyperglycemia reaction gatifloxacin, gemifloxacin, etc.
, high-risk groups are the elderly who use oral hypoglycemic drugs2 type diabetes, especially those with renal insufficiency
.
Drug Interactions: Combination with oral hypoglycemic drugs may cause severe hypoglycemia or hyperglycemia, and blood glucose monitoring should be strengthened when combined use is required
.
Four other 1.
Musculoskeletal system reactions such as tendinitis, tendon rupture, can occur in a few hours or days after the start of use, or a few months after the end of treatment, can occur bilaterally
.
It can involve multiple tendons, but the Achilles tendon is the most common
.
High-risk groups are older adults > 60 years of age, those on glucocorticoid therapy, those receiving heart/lung/kidney transplants, athletes or those engaged in strenuous activity, and those with prior tendon problems (if rheumatoid arthritis) , Renal insufficiency
.
Those with a history of tendon disease or tendonitis and tendon rupture should avoid use
.
It should be discontinued after tendon pain, swelling, inflammation or rupture
.
2.
Photosensitivity reactions such as rashes and phototoxicity Moderate to severe photosensitivity/phototoxicity reactions occur after exposure to sunlight or UV light after the use of fluoroquinolones, which may manifest as excessive sunburn reactions (such as burning sensations) , erythema, blisters, exudation, edema), often in areas exposed to light (usually the "V" area of the neck, the surface of the extensor muscles of the forearm, the back of the hand), taking care to avoid excessive exposure to light sources
.
The high-risk group for phototoxicity is cystic pulmonary fibrosis, and the drug should be discontinued if it occurs
.
3.
Hepatobiliary system reactions such as hepatitis, jaundice, acute liver necrosis,
etc.
Severe hepatotoxicity, such as moxifloxacin, is more common in the course of treatment> 14d
.
4.
Hematological reactions such as anemia including hemolytic anemia and aplastic anemia, thrombocytopenia including thrombotic thrombocytopenic purpura, leukopenia and agranulocytosis
.
5.
Clostridium difficile-related diarrhea, allergic reactions,
etc.
References: 1.
Chen Xinqian et al.
Chen Xinqian's new edition of Pharmacology [M].
Beijing: People's Health Publishing House, 2018: 102-1092.
Indications and rational application of quinolones in the treatment of infectious diseases: expert consensus[ J].
Chinese Journal of Infection and Chemotherapy, 2009, 9(2): 81-863.
Expert consensus on the rational use of quinolones in the treatment of lower respiratory tract infections [J].
Chinese Journal of Tuberculosis and Respiratory Medicine, 2009, 32(9): 646 -6534.
FDA: Fluoroquinolonesincrease odds of aortic dissection, AAA rupture.
Healio.
December 20,20185.
CFDA Announcement on Amending the Instructions for Systemic Fluoroquinolones (No.
79, 2017) 6.
Adverse Drug Reactions Information Circular (Issue 58) Concerned About Serious Adverse Reactions of Fluoroquinolones.
November 21, 2013 7.
Tong Rongsheng et al.
Drug Comparison and Clinical Rational Selection - Respiratory Diseases [M].
Beijing: People's Health Publishing House, 2014:121-128,268-2778.
Expert consensus on perioperative application of non-opioid analgesics in adults[J].
International Journal of Anesthesiology and Resuscitation,2019,40(1):2
, are a class of synthetic broad-spectrum antibacterial drugs
.
It has the characteristics of rapid sterilization, strong tissue penetration, high oral bioavailability, long elimination half-life, and no cross-resistance with other antibacterial drugs.
It can be clinically used for respiratory system infections, intestinal infections, urinary system infections, and skin and soft tissue infections.
, Bone and joint infections,
etc.
1.
Cardiovascular reactions Quinolones such as levofloxacin, moxifloxacin, gatifloxacin, and sparfloxacin can cause ventricular arrhythmia, prolongation of QT interval, and occasionally develop to severe arrhythmia such as torsades de pointes (TdP).
.
Original QT interval prolongation, female, elderly, congestive heart failure, concomitant use of class IA and III antiarrhythmic drugs, combined use of other QT interval prolonging drugs, combined use of CYP450 inhibitors, hypokalemia, Hypomagnesemia and renal insufficiency are risk factors for QT interval prolongation
.
Use with caution in patients with prolonged QT interval
.
On December 20, 2018, the FDA issued a safety alert stating that fluoroquinolones may increase the risk of aortic dissection and rupture of aortic aneurysms, and their use is associated with an increased risk of aortic dissection or rupture of aortic aneurysms, which may lead to Bleeding or even death occurs
.
Fluoroquinolones should not be used in people at increased risk, such as those with blockages or aneurysms of the aorta or other blood vessels, people with high blood pressure, certain genetic disorders involving blood vessels, and the elderly, unless there are no other treatment options
.
Second, fluoroquinolones should not be given to people with aneurysms or a risk factor, including those with peripheral atherosclerotic vascular disease, hypertension, Marfan syndrome and Ehlers-Danlos syndrome, and the elderly
.
Drug interactions: Combined use with macrolides, class IA or class III antiarrhythmic drugs, and cisapride can increase the risk of QT interval prolongation, which can lead to fatal arrhythmias in severe cases.
Avoid combined use as much as possible.
.
Combination of sparfloxacin with phenothiazine antipsychotics, tricyclic antidepressants, etc.
may increase the risk of arrhythmia, and it is prohibited to use them together
.
Second nervous system reactions such as levofloxacin, ciprofloxacin, enoxacin, etc.
, manifested as dizziness (prone to the elderly), headache, insomnia, anxiety, disturbance of consciousness or mental disorders (high-risk groups are the same with NSAIDs or CYP450 enzyme inhibition) Drugs), convulsions (high-risk groups include history of epilepsy, brain trauma, hypoxemia, combined use of NSAIDs or theophylline),
etc.
Quinolones can inhibit the effect of gamma-aminobutyric acid (GABA), which can induce epilepsy, and should be used with caution in patients with a history of epilepsy
.
In addition, patients with renal insufficiency who use quinolones mainly excreted by the kidneys without reducing their doses are prone to nervous system reactions
.
Others include convulsions, increased intracranial pressure (including pseudotumors), nightmares, tremors, and hallucinations
.
Drug Interactions: Combined use with NSAIDs (except aspirin) can increase the incidence of adverse events in the central nervous system, manifested as insomnia, nervousness and convulsions.
Avoid combined use as much as possible
.
For example, third-generation quinolones such as lomefloxacin and enoxacin are used in combination with flurbiprofen axetil, the latter can enhance the former's inhibitory effect on the release of gamma-aminobutyric acid, which may cause convulsions; the combination of enoxacin and ibuprofen , there is a risk of convulsions
.
In addition, fluoroquinolones have neuromuscular blocking activity, and may aggravate the symptoms of myasthenia gravis in patients with myasthenia gravis.
The use of fluoroquinolones in patients with myasthenia gravis may cause death or require assisted breathing
.
Furthermore, peripheral neuropathy develops soon after fluoroquinolones use, usually within a few days, and in some patients symptoms persist for more than a year despite discontinuation
.
It did not appear to be associated with time of treatment or age, and the incidence was unclear
.
Stop if symptoms of peripheral neuropathy such as pain, burning, tingling, numbness, and/or weakness or other sensory changes such as light touch, pain, temperature, position, and vibration occur.
Substitute a fluoroquinolone with another non-fluoroquinolone antibacterial drug
.
Unless the benefits of continuing fluoroquinolone therapy outweigh the risks
.
Dysglycemia (such as symptomatic hyperglycemia and hypoglycemia) caused by the use of fluoroquinolones in the three endocrine systems may be a similar reaction, which mostly occurs in diabetic patients who take oral hypoglycemic drugs or insulin at the same time, and hypoglycemia occurs in different fluoroquinolones.
The risk will vary, with moxifloxacin being the highest risk
.
If nausea, vomiting, palpitations, sweating, paleness, hunger, limb tremors, transient syncope, etc.
occur, consider the possibility of blood sugar disorders
.
Such as hypoglycemia reaction levofloxacin, moxifloxacin, gatifloxacin, etc.
, high-risk groups are combined oral hypoglycemic drugs, hyperglycemia reaction gatifloxacin, gemifloxacin, etc.
, high-risk groups are the elderly who use oral hypoglycemic drugs2 type diabetes, especially those with renal insufficiency
.
Drug Interactions: Combination with oral hypoglycemic drugs may cause severe hypoglycemia or hyperglycemia, and blood glucose monitoring should be strengthened when combined use is required
.
Four other 1.
Musculoskeletal system reactions such as tendinitis, tendon rupture, can occur in a few hours or days after the start of use, or a few months after the end of treatment, can occur bilaterally
.
It can involve multiple tendons, but the Achilles tendon is the most common
.
High-risk groups are older adults > 60 years of age, those on glucocorticoid therapy, those receiving heart/lung/kidney transplants, athletes or those engaged in strenuous activity, and those with prior tendon problems (if rheumatoid arthritis) , Renal insufficiency
.
Those with a history of tendon disease or tendonitis and tendon rupture should avoid use
.
It should be discontinued after tendon pain, swelling, inflammation or rupture
.
2.
Photosensitivity reactions such as rashes and phototoxicity Moderate to severe photosensitivity/phototoxicity reactions occur after exposure to sunlight or UV light after the use of fluoroquinolones, which may manifest as excessive sunburn reactions (such as burning sensations) , erythema, blisters, exudation, edema), often in areas exposed to light (usually the "V" area of the neck, the surface of the extensor muscles of the forearm, the back of the hand), taking care to avoid excessive exposure to light sources
.
The high-risk group for phototoxicity is cystic pulmonary fibrosis, and the drug should be discontinued if it occurs
.
3.
Hepatobiliary system reactions such as hepatitis, jaundice, acute liver necrosis,
etc.
Severe hepatotoxicity, such as moxifloxacin, is more common in the course of treatment> 14d
.
4.
Hematological reactions such as anemia including hemolytic anemia and aplastic anemia, thrombocytopenia including thrombotic thrombocytopenic purpura, leukopenia and agranulocytosis
.
5.
Clostridium difficile-related diarrhea, allergic reactions,
etc.
References: 1.
Chen Xinqian et al.
Chen Xinqian's new edition of Pharmacology [M].
Beijing: People's Health Publishing House, 2018: 102-1092.
Indications and rational application of quinolones in the treatment of infectious diseases: expert consensus[ J].
Chinese Journal of Infection and Chemotherapy, 2009, 9(2): 81-863.
Expert consensus on the rational use of quinolones in the treatment of lower respiratory tract infections [J].
Chinese Journal of Tuberculosis and Respiratory Medicine, 2009, 32(9): 646 -6534.
FDA: Fluoroquinolonesincrease odds of aortic dissection, AAA rupture.
Healio.
December 20,20185.
CFDA Announcement on Amending the Instructions for Systemic Fluoroquinolones (No.
79, 2017) 6.
Adverse Drug Reactions Information Circular (Issue 58) Concerned About Serious Adverse Reactions of Fluoroquinolones.
November 21, 2013 7.
Tong Rongsheng et al.
Drug Comparison and Clinical Rational Selection - Respiratory Diseases [M].
Beijing: People's Health Publishing House, 2014:121-128,268-2778.
Expert consensus on perioperative application of non-opioid analgesics in adults[J].
International Journal of Anesthesiology and Resuscitation,2019,40(1):2
