Fluoroquinolone antibiotics

The fluoroquinolones are a family of synthetic broad-spectrum antibiotics, which eradicate bacteria by interfering with DNA replication. However, the fluoroquinolones are relatively ineffective against intracellular pathogens.

Fluoroquinolones can be used as an acute-phase antibiotic for patients on the Marshall Protocol because they produce little or no immunopathology.

Types of fluoroquinolones

All the fluoroquinolones are thought to act in a similar way.

Issues to consider before prescribing fluoroquinolones

The following issues should be addressed when a physician is deciding whether to use fluoroquinolone antibiotics:

Fluoroquinolones are okay under special circumstances

For reasons ranging from prophylaxis to acute infections, Marshall Protocol (MP) are sometimes advised to take an antibiotic different from the ones used on the MP.

===== Notes and comments =====

  • Legacy content

From Joyful 4/4/2012…

As a rule, we typically have 2-6 members a month asking about using a non-MP antibiotic for an acute infection. I've talked a couple times this year with Prof. Marshall about alternative antibiotics. He seems partial to Ceftin and Biaxin. He just posted this yesterday:

Flouroquinolones linked to Retinal Detachment Ceftin looks more attractive every month…

Reuters has a report on a new Canadian study:

https://www.reuters.com/assets/print?aid=USBRE83210420120403

Even though the risk of eye damage is still low, it seems that it might be prudent for physicians to try Ceftin for acute infections, before resorting to the flouroquinolones.

..Trevor..

I can see that the the article you link to may need some updating re: this.

Also, where do you have info on benzos. I think it would be good to quote Dr. Ashton there.

Antibiotics for some reason, sometimes seem to aggravate withdrawal symptoms. However, one class of antibiotics, the quinolones, actually displace benzodiazepines from their binding sites on GABA-receptors. These can precipitate acute withdrawal in people taking or tapering from benzodiazepines. It may be necessary to take antibiotics during benzodiazepine withdrawal but if possible the quinolones should be avoided. (There are at least six different quinolones - ask your doctor if in doubt). From: https://www.benzo.org.uk/manual/bzcha00.htm

===== References =====

1)
Rolain J, Stuhl L, Maurin M, Raoult D. Evaluation of antibiotic susceptibilities of three rickettsial species including Rickettsia felis by a quantitative PCR DNA assay. Antimicrob Agents Chemother. 2002 Sep;46(9):2747-51. doi: 10.1128/AAC.46.9.2747-2751.2002.
[PMID: 12183224] [PMCID: 127393] [DOI: 10.1128/AAC.46.9.2747-2751.2002]
2)
van der Linden PD, Sturkenboom MCJM, Herings RMC, Leufkens HGM, Stricker BHC. Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ. 2002 Jun 1;324(7349):1306-7. doi: 10.1136/bmj.324.7349.1306.
[PMID: 12039823] [PMCID: 113766] [DOI: 10.1136/bmj.324.7349.1306]
3)
Chan EW, Liu KQL, Chui CSL, Sing C, Wong LYL, Wong ICK. Adverse drug reactions - examples of detection of rare events using databases. Br J Clin Pharmacol. 2015 Oct;80(4):855-61. doi: 10.1111/bcp.12474. Epub 2015 Jun 1.
[PMID: 25060360] [PMCID: 4594728] [DOI: 10.1111/bcp.12474]
4)
Etminan M, Forooghian F, Brophy JM, Bird ST, Maberley D. Oral fluoroquinolones and the risk of retinal detachment. JAMA. 2012 Apr 4;307(13):1414-9. doi: 10.1001/jama.2012.383.
[PMID: 22474205] [DOI: 10.1001/jama.2012.383]
5)
Fife D, Zhu V, Voss E, Levy-Clarke G, Ryan P. Exposure to oral fluoroquinolones and the risk of retinal detachment: retrospective analyses of two large healthcare databases. Drug Saf. 2014 Mar;37(3):171-82. doi: 10.1007/s40264-014-0138-y.
[PMID: 24526267] [PMCID: 3936132] [DOI: 10.1007/s40264-014-0138-y]
6)
Eftekhari K, Ghodasra DH, Haynes K, Chen J, Kempen JH, VanderBeek BL. Risk of retinal tear or detachment with oral fluoroquinolone use: a cohort study. Pharmacoepidemiol Drug Saf. 2014 Jul;23(7):745-52. doi: 10.1002/pds.3623. Epub 2014 Apr 22.
[PMID: 24757075] [PMCID: 4094359] [DOI: 10.1002/pds.3623]
7)
Chui CSL, Man KKC, Cheng C, Chan EW, Lau WCY, Cheng VCC, Wong DSH, Yang Kao Y, Wong ICK. An investigation of the potential association between retinal detachment and oral fluoroquinolones: a self-controlled case series study. J Antimicrob Chemother. 2014 Sep;69(9):2563-7. doi: 10.1093/jac/dku145. Epub 2014 May 15.
[PMID: 24833754] [DOI: 10.1093/jac/dku145]
8)
Douros A, Grabowski K, Stahlmann R. Safety issues and drug-drug interactions with commonly used quinolones. Expert Opin Drug Metab Toxicol. 2015 Jan;11(1):25-39. doi: 10.1517/17425255.2014.970166. Epub 2014 Nov 26.
[PMID: 25423877] [DOI: 10.1517/17425255.2014.970166]
9)
Chui CSL, Wong ICK, Wong LYL, Chan EW. Association between oral fluoroquinolone use and the development of retinal detachment: a systematic review and meta-analysis of observational studies. J Antimicrob Chemother. 2015 Apr;70(4):971-8. doi: 10.1093/jac/dku507. Epub 2014 Dec 18.
[PMID: 25525200] [DOI: 10.1093/jac/dku507]
10)
Alves C, Penedones A, Mendes D, Batel Marques F. A systematic review and meta-analysis of the association between systemic fluoroquinolones and retinal detachment. Acta Ophthalmol. 2016 Aug;94(5):e251-9. doi: 10.1111/aos.12931. Epub 2016 Feb 5.
[PMID: 26846201] [DOI: 10.1111/aos.12931]
11)
Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015 Nov 18;5(11):e010077. doi: 10.1136/bmjopen-2015-010077.
[PMID: 26582407] [PMCID: 4654346] [DOI: 10.1136/bmjopen-2015-010077]
12)
Raguideau F, Lemaitre M, Dray-Spira R, Zureik M. Association Between Oral Fluoroquinolone Use and Retinal Detachment. JAMA Ophthalmol. 2016 Apr;134(4):415-21. doi: 10.1001/jamaophthalmol.2015.6205.
[PMID: 26967005] [DOI: 10.1001/jamaophthalmol.2015.6205]