The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today.

http://ilena-rosenthal.blogspot.com
Health Lover

Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
Propaganda false claim:

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~

He also hawks the now admittedly dangerous flu vaccinations ...

http://groups.google.com/group/sci.m...a42f7671703084
Sun, 14 Jan 2007 17:36:53 GMT

Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
claim:

Lots of things are not "needed". Getting the flu shot, however,
reduces the likelihood of getting the flu and if you do get it,
reduces it the severity and duration of symptoms. For a pretty benign
shot, the effects are overwhelmingly positive. Why take a chance of
getting the flu if you can avoid it? Seems like only an idiot would
do that. Are you an idiot? No need to answer.

~~~~~~~~~~~`

God help his patients who are faced with the cowardly pharma shill as
a medical doctor.

Read this information about FQ drugs that Fake Skeptic Stahl dismisses
with one grunt.

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~~~~~
http://www.fqresearch.org/

The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
include:
Tendon and Muscle Pain Insomnia Burning Pain Digestion
Disorders Anxiety Heart Problems Vision Disorders Ringing
in the Ears Rashes Hyperglycemia Depersonalization Mental
Disorders Seizures PAIN Liver Failure Stroke Other Adverse
Reactions

What I said - I speak for myself only - is that cipro, when considering abx,
is a relatively safe one. All abx have side effects. Things like
resistance is something they all have to contend with. What you did was
simply give the laundry list of possible adverse events of cipro. For some
reason, you capped PAIN as one.

I'll indulge you - the medically clueless. Penicilling (PCN) analogues are
the most frequent class to have allergic reactions to. PCN can cause
anaphylaxis and death. I'd capitalize that long before "pain". I've been
prescribing abx for years. I've ONCE had to have a patient change from
cipro to another med because of side effects. In my field (Urology), we use
cipro more than many others. I have people on it for months at a time.
Months. No problems. I have had to change NUMEROUS other abx b/c of side
effects ranging from the concerning rash/hives to the less serious "I think
my stomach gets upset". Both my kids, it t

"Ilena Rose" wrote in message
...
http://ilena-rosenthal.blogspot.com
Health Lover

Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
Propaganda false claim:

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~

He also hawks the now admittedly dangerous flu vaccinations ...

http://groups.google.com/group/sci.m...a42f7671703084
Sun, 14 Jan 2007 17:36:53 GMT

Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
claim:

Lots of things are not "needed". Getting the flu shot, however,
reduces the likelihood of getting the flu and if you do get it,
reduces it the severity and duration of symptoms. For a pretty benign
shot, the effects are overwhelmingly positive. Why take a chance of
getting the flu if you can avoid it? Seems like only an idiot would
do that. Are you an idiot? No need to answer.

~~~~~~~~~~~`

God help his patients who are faced with the cowardly pharma shill as
a medical doctor.

Read this information about FQ drugs that Fake Skeptic Stahl dismisses
with one grunt.

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~~~~~
http://www.fqresearch.org/

The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
include:
Tendon and Muscle Pain Insomnia Burning Pain Digestion
Disorders Anxiety Heart Problems Vision Disorders Ringing
in the Ears Rashes Hyperglycemia Depersonalization Mental
Disorders Seizures PAIN Liver Failure Stroke Other Adverse
Reactions

Finishing my thought below... my computer bugged out on me...

.... both my kids have had some sort of negative reaction to PCN based meds.
These things happen. You know what's worse than the potential problems with
cipro? An untreated infection! In my field, we see a lot of multi-drug
resistant pseudomonal infections (a type of bacteria). Cipro (the and other
quinolones) is often one that it is susceptible to. It's often the ONLY abx
that the patient doesn't need an IV for, something of HUGE significance when
considering cost, compliance, a drain on resources, and potentially saving
needed hospital beds for more ill patients.

See Ilena - these topics need to be better thought out. It's not always so
A is bad and B is good. I won't indulge your desire to get into vaccines
again. Been there done that. I get my flu shot annually. I think it's a
great idea for all people. The flu sucks. These possible long term side
effects are unproven and probably just silly. That said, even if real, I'll
take my chances because I don't want the flu again and in my line of work, I
can't afford to miss an unplanned week of work.

"Skeptic" wrote in message
news:Gonuj.39613$9j6.288@attbi_s22...
What I said - I speak for myself only - is that cipro, when considering
abx, is a relatively safe one. All abx have side effects. Things like
resistance is something they all have to contend with. What you did was
simply give the laundry list of possible adverse events of cipro. For
some reason, you capped PAIN as one.

I'll indulge you - the medically clueless. Penicilling (PCN) analogues
are the most frequent class to have allergic reactions to. PCN can cause
anaphylaxis and death. I'd capitalize that long before "pain". I've been
prescribing abx for years. I've ONCE had to have a patient change from
cipro to another med because of side effects. In my field (Urology), we
use cipro more than many others. I have people on it for months at a
time. Months. No problems. I have had to change NUMEROUS other abx b/c
of side effects ranging from the concerning rash/hives to the less serious
"I think my stomach gets upset". Both my kids, it t

"Ilena Rose" wrote in message
...
http://ilena-rosenthal.blogspot.com
Health Lover

Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
Propaganda false claim:

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~

He also hawks the now admittedly dangerous flu vaccinations ...

http://groups.google.com/group/sci.m...a42f7671703084
Sun, 14 Jan 2007 17:36:53 GMT

Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
claim:

Lots of things are not "needed". Getting the flu shot, however,
reduces the likelihood of getting the flu and if you do get it,
reduces it the severity and duration of symptoms. For a pretty benign
shot, the effects are overwhelmingly positive. Why take a chance of
getting the flu if you can avoid it? Seems like only an idiot would
do that. Are you an idiot? No need to answer.

~~~~~~~~~~~`

God help his patients who are faced with the cowardly pharma shill as
a medical doctor.

Read this information about FQ drugs that Fake Skeptic Stahl dismisses
with one grunt.

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~~~~~
http://www.fqresearch.org/

The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
include:
Tendon and Muscle Pain Insomnia Burning Pain Digestion
Disorders Anxiety Heart Problems Vision Disorders Ringing
in the Ears Rashes Hyperglycemia Depersonalization Mental
Disorders Seizures PAIN Liver Failure Stroke Other Adverse
Reactions

On Feb 18, 2:11*pm, "Skeptic" wrote:
What I said - I speak for myself only - is that cipro, when considering abx,
is a relatively safe one. *All abx have side effects. *Things like
resistance is something they all have to contend with. *What you did *was
simply give the laundry list of possible adverse events of cipro. *For some
reason, you capped PAIN as one.

I'll indulge you - the medically clueless. *Penicilling (PCN) analogues are
the most frequent class to have allergic reactions to. *PCN can cause
anaphylaxis and death. *I'd capitalize that long before "pain". *I've been
prescribing abx for years. *I've ONCE had to have a patient change from
cipro to another med because of side effects. *In my field (Urology), we use
cipro more than many others. *I have people on it for months at a time.
Months. *No problems. *I have had to change NUMEROUS other abx b/c of side
effects ranging from the concerning rash/hives to the less serious "I think
my stomach gets upset". *Both my kids, it t

"Ilena Rose" wrote in message

...



http://ilena-rosenthal.blogspot.com
Health Lover

Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
Propaganda false claim:

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~

He also hawks the now admittedly dangerous flu vaccinations ...

http://groups.google.com/group/sci.m..._thread/thread...
Sun, 14 Jan 2007 17:36:53 GMT

Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
claim:

Lots of things are not "needed". *Getting the flu shot, however,
reduces the likelihood of getting the flu and if you do get it,
reduces it the severity and duration of symptoms. *For a pretty benign
shot, the effects are overwhelmingly positive. *Why take a chance of
getting the flu if you can avoid it? *Seems like only an idiot would
do that. *Are you an idiot? No need to answer.

~~~~~~~~~~~`

God help his patients who are faced with the cowardly pharma shill as
a medical doctor.

Read this information about FQ drugs that Fake Skeptic Stahl dismisses
with one grunt.

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~~~~~
http://www.fqresearch.org/

The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
include:
Tendon and Muscle Pain * * *Insomnia * * *Burning Pain * * Digestion
Disorders * Anxiety * Heart Problems * *Vision Disorders * * Ringing
in the Ears * *Rashes * Hyperglycemia * * Depersonalization Mental
Disorders * *Seizures * *PAIN *Liver Failure *Stroke * Other Adverse
Reactions- Hide quoted text -

- Show quoted text -

I would have to respectfully disagree with these assertions. If you
had taken the time to even take a look at the website cited, www.fqresearch.org
you will find well over 4000 medical journal entries, clinical
studies, post marketing reports, etc. (all published in the leading
medical journals such as The New England Journal of Medicine, The
Southern Journal, The Annals of Pharmacology, as well as readily found
on PubMed), that clearly and irrevocably rejects such a position. It
is also to be noted that there are currently TWO petitions filed with
the FDA (Public Citizen as well as the Attorney General of the State
of Illinois) seeking not only "Black Box" warnings but also "Dear
Doctor Letters". In fact in January of 2008 suit was filed in Federal
Court seeking to compel the FDA, as required by law, to respond to
these petitions. On February 14, 2008 Bayer issued (In Europe) a
"Dear Doctor" letter concering Avelox in relation to SEVERE LIVER
DAMAGE AND SEVERE SKIN DAMAGE. More than 50% of these drugs have been
removed from clinical practice due to severe toxicity issues resulting
in numerous DEATHS. This hardly sounds to me like a "safe
antibiotic". To continue this argument you will also find that
Levaquin has by far the worse safety profile of all the quinolone
drugs. The NDA (New Drug Application) studies revealed an adr rate
greater than 40% (one or MORE adverse reactions) as well as numerous
fatalities. We find the same statistics for just about all the drugs
in this class.

Perhaps I am a bit bias in this presentation as well. You see it was
an urologist, who believed this same unsupported drug company
propaganda, that blinded and crippled me for life. That was eight
years ago. I was given floxin, cipro and finally levaquin for a
fricking KIDNEY STONE. And this "safe" combination damn near killed
me. Did my urologist even recognize that I was having serious and
severe adrs to these drugs? Nope. Just kept increasing the dose
until I ended up in ER.

Permanent diplopia, chronic tendonitis, cystic formations on the liver
and kidneys, swollen lymph nodes, severe rash, hair literally falling
out, digestive system shot, pancreatitis, severely increased white
cell count, tendons shrunk on the hands so bad I can hardly even bend
them anymore, chronic fatigue and constant never ending pain for the
past eight years. All from a "safe" antibiotic? Before you reject
this out of hand keep in mind that FOUR different doctors have already
CONFIRMED

(cont) that these drugs were responsible. My rhuematologist,
hematologist, orthopedic surgeon, as well as an opthoneurologist. For
the past eight years as a result of this careless scripting my health
has continued to decline on a daily basis. Prior to this I had
absolutely NO medical problems to speak of. I developed a kidney
stone as a result of a prior regime of cipro (yes this can indeed
cause kidney stones) to treat a mild case of epidemitis that could
have just as easily been treated with any number of much safer
antibiotics. Bitter? You betcha. But this does nothing to change
the true safety profile of this class. The NUMBER ONE complaint of
patients so affected is the FACT that their treating physician knows
nothing about these severe reactions and refuses to associate with the
use of these drugs. The ignorance found within the medical community
is appalling. No offense meant in the least but you appear to be one
such physcian that they are complaining about.

One does not have an Attorney General seeking Black Box warnings for
"safe" drugs. They do however have their use. That being a drug of
last resort when all else has failed the patient. They are NOT and
CANNOT be considered a first line agent for any disease state. On
medications.com, one of the most respected drug site to be found on
the Internet reveals over 1,700 post citing to severe adverse
reactions to levaquin alone. Of ALL the drugs found on that site,
whether a quinolone or otherwise, more adverse reactions have been
posted concerning levaquin. And this site list thousands of drugs.
More adverse reactions have been reported on that site for the
quinolone class than ALL the other drugs combined with the lone
exception being a birth control pill. These statistics are repeated
throughout the Internet. As well as to be found on MedMatch. I know
this for a fact as I had obtained this data under the freedom of
information act. (concerning medwatch) And less than 1-4% of such
reactions are ever reported to the FDA.

As such you are more than welcomed to continue to subject your
patients to this unacceptable risk and then bitch when they sue you
for malpractice. For using this class for anything less than a life
threatening situation has been found by the courts to be exactly that.

"davidtfull" wrote in message
...
On Feb 18, 2:11 pm, "Skeptic" wrote:
What I said - I speak for myself only - is that cipro, when considering
abx,
is a relatively safe one. All abx have side effects. Things like
resistance is something they all have to contend with. What you did was
simply give the laundry list of possible adverse events of cipro. For some
reason, you capped PAIN as one.

I'll indulge you - the medically clueless. Penicilling (PCN) analogues are
the most frequent class to have allergic reactions to. PCN can cause
anaphylaxis and death. I'd capitalize that long before "pain". I've been
prescribing abx for years. I've ONCE had to have a patient change from
cipro to another med because of side effects. In my field (Urology), we
use
cipro more than many others. I have people on it for months at a time.
Months. No problems. I have had to change NUMEROUS other abx b/c of side
effects ranging from the concerning rash/hives to the less serious "I
think
my stomach gets upset". Both my kids, it t

"Ilena Rose" wrote in message

...



http://ilena-rosenthal.blogspot.com
Health Lover

Pseudoskeptic, Brandon C Stahl made this unsubstantiated, Pharma
Propaganda false claim:

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~

He also hawks the now admittedly dangerous flu vaccinations ...

http://groups.google.com/group/sci.m..._thread/thread...
Sun, 14 Jan 2007 17:36:53 GMT

Brandon C Stahl, pseudo Skeptic made this absurd, Vaccination Lobby
claim:

Lots of things are not "needed". Getting the flu shot, however,
reduces the likelihood of getting the flu and if you do get it,
reduces it the severity and duration of symptoms. For a pretty benign
shot, the effects are overwhelmingly positive. Why take a chance of
getting the flu if you can avoid it? Seems like only an idiot would
do that. Are you an idiot? No need to answer.

~~~~~~~~~~~`

God help his patients who are faced with the cowardly pharma shill as
a medical doctor.

Read this information about FQ drugs that Fake Skeptic Stahl dismisses
with one grunt.

"They're actually one of the safe, more effective antibiotics
available today."

~~~~~~~~~~~~~~~~~
http://www.fqresearch.org/

The Adverse Drug Reactions (ADRS) Associated with the Fluoroquinolones
include:
Tendon and Muscle Pain Insomnia Burning Pain Digestion
Disorders Anxiety Heart Problems Vision Disorders Ringing
in the Ears Rashes Hyperglycemia Depersonalization Mental
Disorders Seizures PAIN Liver Failure Stroke Other Adverse
Reactions- Hide quoted text -

- Show quoted text -

I would have to respectfully disagree with these assertions. If you
had taken the time to even take a look at the website cited,
www.fqresearch.org
you will find well over 4000 medical journal entries, clinical
studies, post marketing reports, etc. (all published in the leading
medical journals such as The New England Journal of Medicine, The
Southern Journal, The Annals of Pharmacology, as well as readily found
on PubMed), that clearly and irrevocably rejects such a position.

REPLY:

Disagree away. Simple fact - if there were 4000 articles showing their
obious danger, no government agency in the country would allow their use, no
hospital would accept their being used, and no physician would recommend
them as treatment. Allow me to offer you a piece of advice - the
information that ILena offers is biased, junk science, and invariably not
data... just people's opinions. I am not denying there are not people out
there that think they are dangerous any more than you would deny there are
people who think aliens from other planets walk among us. Belief in
something doesn't make it true.

What I have done is read the actual published DATA articles on this that
have shown no obvious problems.

"davidtfull" wrote in message
...
(cont) that these drugs were responsible. My rhuematologist,
hematologist, orthopedic surgeon, as well as an opthoneurologist. For
the past eight years as a result of this careless scripting my health
has continued to decline on a daily basis. Prior to this I had
absolutely NO medical problems to speak of. I developed a kidney
stone as a result of a
prior regime of cipro (yes this can indeed
cause kidney stones)

Interesting - can you please cite me the reference that proved that cipro
use increases risk of stones over placebo? Thanks!

to treat a mild case of epidemitis that could
have just as easily been treated with any number of much safer
antibiotics.

Such as? Cipro is a great drug to treat epididymitis (I'm assuming that is
what you meant). If left untreated or inadequately treated, you can end up
hospitalized with IV antibiotics.

Bitter? You betcha. But this does nothing to change
the true safety profile of this class. The NUMBER ONE complaint of
patients so affected is the FACT that their treating physician knows
nothing about these severe reactions and refuses to associate with the
use of these drugs. The ignorance found within the medical community
is appalling. No offense meant in the least but you appear to be one
such physcian that they are complaining about.

Then provide some evidence.

One does not have an Attorney General seeking Black Box warnings for
"safe" drugs. They do however have their use. That being a drug of
last resort when all else has failed the patient. They are NOT and
CANNOT be considered a first line agent for any disease state.

Correction - they are. That's a medical fact my friend.

On
medications.com, one of the most respected drug site to be found on
the Internet reveals over 1,700 post citing to severe adverse
reactions to levaquin alone. Of ALL the drugs found on that site,
whether a quinolone or otherwise, more adverse reactions have been
posted concerning levaquin. And this site list thousands of drugs.
More adverse reactions have been reported on that site for the
quinolone class than ALL the other drugs combined with the lone
exception being a birth control pill. These statistics are repeated
throughout the Internet.

And if that is your basis your "facts" I now see why you're so off. You've
fallen into a self-fulfilling prophecy.

As well as to be found on MedMatch. I know
this for a fact as I had obtained this data under the freedom of
information act. (concerning medwatch) And less than 1-4% of such
reactions are ever reported to the FDA.

Things you read on the internet are not "fact". Many are comments from 12
years olds who's girlfriend hasn't logged on yet.

As such you are more than welcomed to continue to subject your
patients to this unacceptable risk and then bitch when they sue you
for malpractice.

Can't sue for following the standard of care. And as I mentioned
previously, the quinolones is one of antibiotics I have the absolute fewest
complaints over. And believe me, we hear about it from patients when a
medication is causing some adverse reaction. But really, you have 12 year
olds to trust...

For using this class for anything less than a life
threatening situation has been found by the courts to be exactly that.

Um, no, it has not.

TENDON DAMAGE

1972

Nalidixic Acid arthralgia
Bailey et al (CMA Journal 1972; 107 601-605)

1976

Jouirland JP Les ruptures tendineusues. Le tendon normal et
patholoqique
Seminar de Monte Carlo 13-14 February 1976

1983

Norfloxacin induced rheumatic disease
Bailey et al (NZ Med J 1983; 96; 590)

1985

100 reported tendinopathies 1985-1992 France
In France, between 1985 and 1992, 100 patients who were being managed
with fluoroquinolones had tendon disorders, which included thirty-one
ruptures (Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of
tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)
http://www.studiomedico.it/allegati/achille.pdf

1987

Ciprofloxacin an update on clinical experience
Areieri et al (Am J of Med 1987 82 381-386)

93 ruptures, 103 tendinopathies, 20 tenasynovitis, 1987-1997
Source: http://www.sma.org/smj1999/junesmj99/harrell.pdf

1988

McEwan SR, Davey PG. Ciprofloxacin and tenosynovitis. Lancet 1988; 2:
900.

Adverse effects of fluoroquinolones
Halkin et al (Rev Infect Dis 1988 10 258-261)

Ciprofloxacin and tenosynovitis
McEwan et al ( Lancet 1988 15 900)

Tendon disorders attributed to fluoroquinolones; a study on 42
spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care
and Research 45; 2001 pages

1989

Arthritis induced by norfloxacin
Jeandel et al (J Rheumatol 1989 16 560-561)

1990

Histologic and Histochemical Changes in Articular Cartilages of
Immature Beagle Dogs Dosed with Difloxacin, a Fluoroquinolone
J.E. Kurkhardt et al (Vet Pathol 27;162-170, 1990)

1991

Rheumatolgical side effects of quinolones
Ribard et al (Baillere's Clin Rheumatol 1991 5 175-191)

Perrot S, Ziza JM, De Bourran-Cauet G, Desplaces N, Lachand AT.
[A new complication related to quinolones: rupture of Achilles tendon]
Presse Med. 1991 Jul 6-13;20(26):1234. French. No abstract available.
PMID: 1831902 [PubMed - indexed for MEDLINE]

1992

Seven Achilles tendinitis including three complicated by rupture
during fluoroquinolone therapy
Ribard et al (J Rheumatol 1992; 19; 1479-1481)

704 achilles tendinitis, 38 ruptures 1992-1998 Netherlands
Fluoroquinolone use and the change in incidence of tendon rupture in
the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July
1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38
had Achilles tendon rupture
source: http://bmj.com/cgi/content/full/324/7349/1306

100 reported tendinopathies 1985-1992 France
In France, between 1985 and 1992, 100 patients who were being managed
with fluoroquinolones had tendon disorders, which included thirty-one
ruptures (Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of
tendon disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)
http://www.studiomedico.it/allegati/achille.pdf

Ribard P, Audisio F, Kahn MF, De Bandt M, Jorgensen C, Hayem G, Meyer
O, Palazzo E.
Seven Achilles tendinitis including 3 complicated by rupture during
fluoroquinolone therapy.
J Rheumatol. 1992 Sep;19(9):1479-81.
PMID: 1433021 [PubMed - indexed for MEDLINE]

Perrot S, Kaplan G, Ziza JM.
[3 cases of Achilles tendinitis caused by pefloxacin, 2 of them with
tendon rupture]
Rev Rhum Mal Osteoartic. 1992 Feb;59(2):162. French. No abstract
available.
PMID: 1604233 [PubMed - indexed for MEDLINE]

Lee WT, Collins JF.
Ciprofloxacin associated bilateral achilles tendon rupture.
Aust N Z J Med. 1992 Oct;22(5):500. No abstract available.
PMID: 1445042 [PubMed - indexed for MEDLINE]

Blanche P, Sereni D, Sicard D, Christoforov B.
[Achilles tendinitis induced by pefloxacin. Apropos of 2 cases]
Ann Med Interne (Paris). 1992;143(5):348. French. No abstract
available.
PMID: 1482040 [PubMed - indexed for MEDLINE]

Olivieri I, Padula A, Lisanti ME, Braccini G.
Longstanding HLA-B27 associated Achilles tendinitis.
Ann Rheum Dis. 1992 Nov;51(11):1265. No abstract available.
PMID: 1466609 [PubMed - indexed for MEDLINE]

1993

Spontaneous bilateral rupture of the Achille's tendon in a renal
transplant recipient
Mainard et al (Nephron 1993;65- 491-492)

Boulay I, Farge D, Haddad A, Bourrier P, Chanu B, Rouffy J
[Tendinopathy caused by ciprofloxacin with possible partial rupture of
Achilles tendon]
Ann Med Interne (Paris). 1993;144(7):493-4. French. No abstract
available.
PMID: 8141519 [PubMed - indexed for MEDLINE]

1994

Royer RJ, Pierfitte C, Netter P.
Features of tendon disorders with fluoroquinolones.
Therapie. 1994 Jan-Feb;49(1):75-6. No abstract available.
PMID: 8091374 [PubMed - indexed for MEDLINE]

Armengol S, Moreno JA, Xirgu J, Torrabadella P, Tomas R.
[Ciprofloxacin as a cause of a behavior disorder in a patient admitted
into intensive care]
Enferm Infecc Microbiol Clin. 1994 May;12(5):271-2. Spanish. No
abstract available.
PMID: 8049295 [PubMed - indexed for MEDLINE]

Donck JB, Segaert MF, Vanrenterghem YF.
Fluoroquinolones and Achilles tendinopathy in renal transplant
recipients.
Transplantation. 1994 Sep 27;58(6):736-7. No abstract available.
PMID: 7940700 [PubMed - indexed for MEDLINE]

Onieal ME.
Achilles injuries.
J Am Acad Nurse Pract. 1994 Mar;6(3):125-6. No abstract available.
PMID: 8003362 [PubMed - indexed for MEDLINE]

Scioli MW.
Achilles tendinitis.
Orthop Clin North Am. 1994 Jan;25(1):177-82. Review.
PMID: 8290227 [PubMed - indexed for MEDLINE]

Hernandez MV, Peris P, Sierra J, Collado A, Munoz-Gomez J.
[Tendinitis due to fluoroquinolones. Description of 2 cases]
Med Clin (Barc). 1994 Sep 10;103(7):264-6. Review. Spanish.
PMID: 7934295 [PubMed - indexed for MEDLINE]

Achilles tenditinis and tendon rupture due to fluoroquinolone therapy
Huston et al (New England Journal of Medicene 1994 331 748)

Royer, R. J.; Pierfitte, C.; and Netter, P.: Features of tendon
disorders with fluoroquinolones. Therapie, 49: 75-76, 1994.)

Dekens-Konter JA, Knol A, Olsson S, Meyboom RH, de Koning GH.
[Tendinitis of the Achilles tendon caused by pefloxacin and other
fluoroquinolone derivatives]
Ned Tijdschr Geneeskd. 1994 Mar 5;138(10):528-31. Dutch.
PMID: 8139714 [PubMed - indexed for MEDLINE]

Prantera C, Kohn A, Zannoni F, Spimpolo N, Bonfa M.
Metronidazole plus ciprofloxacin in the treatment of active,
refractory Crohn's disease: results of an open study.
J Clin Gastroenterol. 1994 Jul;19(1):79-80. No abstract available.
PMID: 7930441 [PubMed - indexed for MEDLINE]

Van Linthoudt D, D'Oro A, Ott H.
[What is your diagnosis? Bilateral Achilles tendinitis associated with
quinolone treatment]
Schweiz Rundsch Med Prax. 1994 Feb 22;83(8):201-2. German. No abstract
available.
PMID: 8134743 [PubMed - indexed for MEDLINE]

Kawada A, Hiruma M, Morimoto K, Ishibashi A, Banba H.
Fixed drug eruption induced by ciprofloxacin followed by ofloxacin.
Contact Dermatitis. 1994 Sep;31(3):182-3. No abstract available.
PMID: 7821014 [PubMed - indexed for MEDLINE]

Guharoy SR.
Serum sickness secondary to ciprofloxacin use.
Vet Hum Toxicol. 1994 Dec;36(6):540-1.
PMID: 7900274 [PubMed - indexed for MEDLINE]


1995

Szarfman A, Chen M, Blum MD. More on fluoroquinolone antibiotics and
tendon rupture. N Engl J Med 1995; 332: 193[Free Full Text].

Magnesium Deficiency Induces Joint Cartilage Lesions in Juvenile Rats
which are Identical to Quinolone Induced Arthropathy
Stahlmann et al (Antimicrobial Agents and Chemotherapy, Sept., 1995 pg
2013-2018)

Pierfitte C, Gillet P, Royer RJ
More on fluoroquinolone antibiotics and tendon rupture.
N Engl J Med. 1995 Jan 19;332(3):193. No abstract available.
PMID: 7800022 [PubMed - indexed for MEDLINE]

Szarfman A, Chen M, Blum MD.
More on fluoroquinolone antibiotics and tendon rupture.
N Engl J Med. 1995 Jan 19;332(3):193. No abstract available.
PMID: 7800023 [PubMed - indexed for MEDLINE]

Norfloxacin induced arthalgia
Terry et al ( J Rheumatol 1995 22 793-794)

Fluoroquinolone Induced Tenosynovitis of the Wrist mimicking de
Quervain's Disease
Gillet et al (British Journal of Rheumatology vol 34 no 6 pg 583-584,
Feb 1995)

Mirovsky Y, Pollack L, Arlazoroff A, Halperin N.
[Ciprofloxacin-associated bilateral acute achilles tendinitis]
Harefuah. 1995 Dec 1;129(11):470-2, 535. Hebrew.
PMID: 8846955 [PubMed - indexed for MEDLINE]

1996

McGarvey WC, Singh D, Trevino SG. Partial Achilles tendon ruptures
associated with fluoroquinolone antibiotics: a case report and
literature review. Foot Ankle Int 1996; 17: 496-498[ISI][Medline].

Pierfitte C, Royer RJ.
Tendon disorders with fluoroquinolones.
Therapie. 1996 Jul-Aug;51(4):419-20. No abstract available.
PMID: 8953821 [PubMed - indexed for MEDLINE]

Hugo-Persson M.
[Rupture of the Achilles tendon after ciproxine therapy]
Lakartidningen. 1996 Apr 17;93(16):1520. Swedish. No abstract
available.
PMID: 8667750 [PubMed - indexed for MEDLINE]

Therapie 1996; 51: 419-420 Tendon disorders with fluoroquinolones 421
cases have been collected by the Centre de Pharmacovigilance, 340 of
tendinitis and 81 cases of tendon rupture.

McGarvey WC, Singh D, Trevino SG.
Partial Achilles tendon ruptures associated with fluoroquinolone
antibiotics: a case report and literature review.
Foot Ankle Int. 1996 Aug;17(8):496-8. Review.
PMID: 8863030 [PubMed - indexed for MEDLINE]

Skovgaard D, Feldt-Rasmussen BF, Nimb L, Hede A, Kjaer M.
[Bilateral Achilles tendon rupture in individuals with renal
transplantation]
Ugeskr Laeger. 1996 Dec 30;159(1):57-8. Danish.
PMID: 9012076 [PubMed - indexed for MEDLINE]

Jagose JT, McGregor DR, Nind GR, Bailey RR.
Achilles tendon rupture due to ciprofloxacin.
N Z Med J. 1996 Dec 13;109(1035):471-2. No abstract available.
PMID: 9006634 [PubMed - indexed for MEDLINE]

Ottosson L.
[An unexpected verdict by the HSAN in a case of Achilles tendon
rupture]
Lakartidningen. 1996 Dec 18;93(51-52):4712, 4715. Swedish. No abstract
available.
PMID: 9011717 [PubMed - indexed for MEDLINE]

Castagnola C, Suhler A.
[Tendinopathy and fluoroquinolones]
Ann Urol (Paris). 1996;30(3):129-30. French.
PMID: 8766149 [PubMed - indexed for MEDLINE]

Foot Ankle Int. 1996 Aug;17(8):496-8.
Partial Achilles tendon ruptures associated with fluoroquinolone
antibiotics: a case report and literature review.

Fluoroquinolone induced arthralgia and Magnetic Resonance Imaging
Loeuille et al (The Journal of Rheumatology volume 23 no 7 , July
1996)

Fluoroquinolone Induced Tendinopathy; Report of Six Cases
Zabraniedkl et al (The Journal of Rhuematology 1996; 23; 3)

Quinolone induced cartilage lesions are not reversible in rats
Forster et al (Arch Toxicol (1996) 70; 474-481)

Maki T, Heinasmaki T, Riutta J, Tikkanen T, Laasonen L, Eklund K.
[Bilateral Achilles tendon rupture caused by oral fluoroquinolones]
Duodecim. 1996;112(19):1818-20. Finnish. No abstract available.
PMID: 10596182 [PubMed - indexed for MEDLINE

ENGLAND
130 reported tendon inflammation or rupture (England, France and
Belgium, 1996)
The group cited 130 reports of tendon inflammation or rupture in
people who used the prescription drug in England, France and Belgium.
The FDA has received at least 52 reports of patients in the U.S. who
have suffered tendon damage
(from public citizens 1996 petition)
Szarfman et al. recommended that the labeling on packaging for
fluoroquinolone be up-dated to include a warning about the possibility
of tendon rupture. In its recommendations on the use of
this class of antibiotics, the British National Formulary
suggested that "at the first sign of pain or inflammation, patients
should discontinue the treatment and rest the affected limb until the
tendon symptoms have resolved."
British National Formulary. No. 32, p. 259. London, British Medical
Association, Royal Pharmaceutical Society of Great Britain, 1996.
{Notice how this labeling change has not be altered since 1996 and
appears to have been copied word for word in every monograph.}

FRANCE
921 reported tendon disorders France
340 reported tendonitis, 81 tendon ruptures 1996, WHO
Adverse drug reactions with fluoroquinolones The French system of drug
surveillance has analyzed the reports of adverse drug reactions (ADRs)
to fluoroquinolones since they were launched. The frequency of
reactions ranges from 1/15000 to 1/208000 case per days of treatment.
Cutaneous disorders and tendon disorders dominate in France, whereas
cutaneous effects and neuropsychiatric disorders are predominant in
the UK; tendon disorders take up only the 5th position. Among the most
unexpected ADRs are the following: 1- Shock 2- Acure renal failure
Tendon ruptures represent 81 cases for 921 reports of tendon disorders
which are related in decreasing order to pefloxacin 1/23130 case per
days of treatment, ofloxin, norfloxacin and ciprofloxacin 1/779600
case per days of treatment. Age and corticosteroids increase the risk
of tendon rupture. Therapie 1996; 51; 419-420 Tendon disorders with
fluoroquinolones 421 cases have been collected by the Centre de
Pharmacovigilance: 340 of tendinitis and 81 of tendon rupture. These
cases were attributed to Peflacine, Oflocet, Noroxine, Ciflox.
Tendinitis was characterized by a bilateral malleolar oedema
associated with a sudden pain. Sometimes this oedema evoked phlebitis.
The tendon rupture was generally preceded by a tendinitis but in half
of the cases it occurred without warning.
Source: http://www.who-umc.org/newsletter/newsltr97_1.html (sic)


1997

Australia. The Adverse Drug Reactions Advisory Committee first
reported tendinitis in association with fluoroquinolone antibiotics in
1997. The Committee has continued to monitor this adverse reaction,
and has now received 60 reports of tendinitis, tensosynovitis and/or
tendon rupture in association with these drugs. Ciprofloxacin was most
frequently cited (55 reports), as well as norfloxacin (4) and enoxacin
(1).
Forty-five reports described tendinitis alone, one report described
tensosynovitis, and 14 reports documented tendon tear or rupture.
Fifty-five of the 60 reports specified the Achilles tendon, including
20 which described bilateral Achilles tendon damage. All 14 reports of
tendon rupture involved the Achilles tendon. The 58 patients ranged in
age from 38 to 91 years (median: 69), with no significant difference
between those with tendinitis and those with tendon rupture.
The daily doses of ciprofloxacin ranged from 500 mg to 2250 mg, with
46% of patients taking 1500 mg and 46% of patients taking 1000 mg
daily. For those who developed tendon rupture, 57% were taking 1500 mg
daily. Time to onset varied from within 24 hours after the drug was
commenced to 3 months after starting, but the majority of cases of
tendinitis occurred within the first week. Time to rupture was longer
with a median time of 2-3 weeks. Known risk factors for these
reactions include old age, renal dysfunction and concomitant
corticosteroid therapy. In the cases reported to the ADRAC, 29 reports
documented concomitant corticosteroid use, and in 21 of the other 31
reports the patients were aged 69 years or older. In the reports of
tendon rupture, 12 of the 14 described either concomitant steroid use
(9) or old age (9).
Prescribers are reminded to be alert for this reaction and to withdraw
the fluoroquinolone immediately when symptoms of tendinitis appear in
order to reduce the risk of tendon rupture.
[See also Pharmaceuticals Newsletter Nos. 7&8, July&August 1997.]
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)
Australia

93 ruptures, 103 tendinopathies, 20 tenasynovitis, 1987-1997
Source: http://www.sma.org/smj1999/junesmj99/harrell.pdf


Poon CC, Sundaram NA.
Spontaneous bilateral Achilles tendon rupture associated with
ciprofloxacin.
Med J Aust. 1997 Jun 16;166(12):665. No abstract available.
PMID: 9216589 [PubMed - indexed for MEDLINE]

Shinohara YT, Tasker SA, Wallace MR, Couch KE, Olson PE.
What is the risk of Achilles tendon rupture with ciprofloxacin?
J Rheumatol. 1997 Jan;24(1):238-9. No abstract available.
PMID: 9002057 [PubMed - indexed for MEDLINE]

Movin T, Gad A, Guntner P, Foldhazy Z, Rolf C.
Pathology of the Achilles tendon in association with ciprofloxacin
treatment.
Foot Ankle Int. 1997 May;18(5):297-9.
PMID: 9167931 [PubMed - indexed for MEDLINE]

Tendons and Fluoroquinolones; Unresolved issues
Kahn et al (Rev Rhum [Engl. Ed.] 1997 64(7-9) 437-439)
(Rev Rhum [Ed. Fr.] 1997 64(7-9) 511-513

Fluoroquinolones tendinitis update Australia
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)

Toxic effects of quinolone antibacterial agents on the musculoskeletal
system in juvenile rats
Yoko Kashida et al (Toxicologic Pathology vol 25 number 6 pages
635-643 1997)

Tendinitis and tendon rupture with fluoroquinolones
ADRAC (The Achilles heel of fluoroquinolones Aust Adv Drug React Bull
1997;16;7, Szarfman et al)

Effects of Ciprofloxacin and Ofloxacin on adult human cartilage in
vitro
(Antimicrob Agents Chemother 1997, Vol 41; issue 11; pages 2562-2565)

Repeated rupture of the extensor tendons of the hand due to
fluoroquinolones, Apropos of a case
Levadoux et al (Ann Chir Main Memb Super 1997, vol 16, issue 2, pgs
130-133)

Benizeau I, Cambon-Michot C, Daragon A, Voisin L, Mejjad O, Thomine
JM, Le Loet X.
Tendinitis of the tibialis anterior with histologic documentation in a
patient under fluoroquinolone therapy.
Rev Rhum Engl Ed. 1997 Jun;64(6):432-3. No abstract available.
PMID: 9513620 [PubMed - indexed for MEDLINE]

1998

Khan KM, Cook JL, Bonar SF, Harcourt PR.
Subcutaneous rupture of the Achilles tendon.
Br J Sports Med. 1998 Jun;32(2):184-5. No abstract available.
PMID: 9631234 [PubMed - indexed for MEDLINE]

Stafford L, Bertouch J.
Reactive arthritis and ruptured Achilles tendon.
Ann Rheum Dis. 1998 Jan;57(1):61. No abstract available.
PMID: 9536827 [PubMed - indexed for MEDLINE]

van der Linden PD, van Puijenbroek EP, Feenstra J, Veld BA,
Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH.
Tendon disorders attributed to fluoroquinolones: a study on 42
spontaneous reports in the period 1988 to 1998. Arthritis Rheum. 2001
Jun;45(3):235-9.
PMID: 11409663 [PubMed - indexed for MEDLINE]

Blanco Andres C, Bravo Toledo R.
[Bilateral tendinitis caused by ciprofloxacin]
Aten Primaria. 1998 Feb 28;21(3):184-5. Spanish. No abstract
available.
PMID: 9607242 [PubMed - indexed for MEDLINE]

Tendon disorders attributed to fluoroquinolones; a study on 42
spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care
and Research 45; 2001 pages 235-239)

Petersen W, Laprell H
[Insidious rupture of the Achilles tendon after ciprofloxacin-induced
tendopathy. A case report]
Unfallchirurg. 1998 Sep;101(9):731-4. German.
PMID: 9816984 [PubMed - indexed for MEDLINE]

West MB, Gow P.
Ciprofloxacin, bilateral Achilles tendonitis and unilateral tendon
rupture--a case report.
N Z Med J. 1998 Jan 23;111(1058):18-9. No abstract available.
PMID: 9484431 [PubMed - indexed for MEDLINE]

Gabutti L, Stoller R, Marti HP.
[Fluoroquinolones as etiology of tendinopathy]
Ther Umsch. 1998 Sep;55(9):558-61. German.
PMID: 9789471 [PubMed - indexed for MEDLINE]

NETHERLANDS
704 achilles tendinitis, 38 ruptures 1992-1998 Netherlands
Fluoroquinolone use and the change in incidence of tendon rupture in
the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July
1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38
had Achilles tendon rupture
source: http://bmj.com/cgi/content/full/324/7349/1306

42 spontaneous reports 1988-1998
Tendon disorders attributed to fluoroquinolones; a study on 42
spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care
and Research 45; 2001 pages 235-239) June 2001
http://www.rheumatology.org/arhp/acnr/2001/0106.html


1999


Harrell RM.
Fluoroquinolone-induced tendinopathy: what do we know?
South Med J. 1999 Jun;92(6):622-5. Review.
PMID: 10372859 [PubMed - indexed for MEDLINE]

Lewis JR, Gums JG, Dickensheets DL.
Levofloxacin-induced bilateral Achilles tendonitis.
Ann Pharmacother. 1999 Jul-Aug;33(7-8):792-5.
PMID: 10466906 [PubMed - indexed for MEDLINE]

van der Linden PD, van de Lei J, Nab HW, Knol A, Stricker BH.
Achilles tendinitis associated with fluoroquinolones.
Br J Clin Pharmacol. 1999 Sep;48(3):433-7.
PMID: 10510157 [PubMed - indexed for MEDLINE]

Van der Linden PD, van de Lei J, Nab HW, Knol A, Stricker BHCh.
Achilles tendinitis associated with fluoroquinolones. Br J Clin
Pharmacol 1999; 48: 433-437[CrossRef][ISI][Medline].

60 reported tendonitis August 1999
Fluoroquinolones tendinitis update Australia
Tendinitis associated with Fluoroquinolone therapy
(Pharmaceuticals Newsletters Nos 7&8 July & August 1997)
Australia
ADRAC Bulletin, vol 18, No 3, August 1999
Tendinitis and tendon rupture with
fluoroquinolones
The Adverse Drug Reactions Advisory Committee (ADRAC) first reported
tendinitis in association with the fluoroquinolone antibiotics in
1997. The Committee has continued to monitor this adverse
reaction, and has now received 60 reports of tendinitis, tenosynovitis
and/or tendon rupture in association with these drugs. Most involved
was ciprofloxacin (55), but there were also reports with norfloxacin
(4) and enoxacin (1). Fortyfive reports described tendinitis alone,
one report described tenosynovitis, and 14 reports documented tendon
tear or rupture. Fifty five of the 60 reports specified the Achilles
tendon, including 20 which described bilateral
Achilles tendon damage. All 14 reports of tendon rupture
involved the Achilles tendon.
Source: http://www.who.int/medicines/library...t/pndec99.html

421 reported tendon disorders and 81 tendon ruptures 1999
Therapie 1996; 51: 419-420 Tendon disorders with fluoroquinolones 421
cases have been collected by the Centre de Pharmacovigilance, 340 of
tendinitis and 81 cases of tendon rupture.

Rev Rhum Engl Ed. 1999 Jul-Sep;66(7-9):419-21.
Suspected role of ofloxacin in a case of arthalgia, myalgia, and
multiple tendinopathy.

Levofloxacin-induced bilateral Achilles tendonitis
Lewis JR, JG Gums, and DL Dickensheets 1999

Inhibition of fibroblast metabolism by a fluoroquinolone antibiotic
Williams et al (American Academy of Orthopedic Surgeons, 1999 Annual
meeting, paper number 118, Geb 5, 1999)

Levofloxacin induced bilateral achilles tendinitis
Lewis et al (The Annals of Pharmacotherapy 1999 July/August, volume 33
pages 792-795)

Fluoroquinolone induced tendinopathy; what do we know?
Harrell et al (South Med J 92(6) 622-625 1999)

Ann Pharmacother. 1999 Jul-Aug;33(7-8):792-5.
Levofloxacin-induced bilateral Achilles tendonitis.

Schwald N, Debray-Meignan S.
Suspected role of ofloxacin in a case of arthalgia, myalgia, and
multiple tendinopathy.
Rev Rhum Engl Ed. 1999 Jul-Sep;66(7-9):419-21.
PMID: 10526383 [PubMed - indexed for MEDLINE]

2000

Fluoroquinolone induced tendinopathy; also occurring with levofloxacin
Fleisch et al (Infection 28 2000 no 4 pages 256-257)

Infection. 2000 Jul-Aug;28(4):256-7.
Fluoroquinolone-induced tendinopathy: also occurring with
levofloxacin.

Quinolone and Tendon Ruptures
Casperian et al (Southern Medical Journal May 2000 vol 93 no 5 pages
488-491)

Evaluation of toxicokinetic variables and arthropathic changes in
juvenile rabbits after oral administration of an ivestigational
fluoroquinolone, pd 117596
Johnson et al (AJVR vol 61 no 11, pages, 1396-1402, November 2000)

Rupture of the patellar ligament one month after treatment with
fluoroquinolone
Rev Chir Orthop Reparatrice Appar Mot. 2000 Sep;86(5):495-7.

FINLAND
42 reported tendinopathies 2000
Finland:
Register of adverse drug reactions in 2000

The majority of ADR reports received among antibacterials concerned
levofloxacin, which is a fluoroquinolone antibiotic. Fourteen of the
reports were on tendinitis or rupture of the Achilles tendon.
Tendinitis caused by fluoroquinolones was discussed in TABU for the
first time in 1996. Since then the ADR register has received a total
of 42 reports on tendinopathies caused by
fluoroquinolones, over a third of which were ruptures of the tendon.
The use of fluoroquinolones has in-creased by about 75% since 1996.
Levofloxacin is responsible for the major part of this increase. It
has been marketed in Finland since mid 1998.
source: http://www.nam.fi/uploads/english/Pu...u22001_eng.pdf

Casado Burgos E, Vinas Ponce G, Lauzurica Valdemoros R, Olive Marques
A.
[Levofloxacin-induced tendinitis]
Med Clin (Barc). 2000 Mar 4;114(8):319. Spanish. No abstract
available.
PMID: 10774524 [PubMed - indexed for MEDLINE]

Casparian JM, Luchi M, Moffat RE, Hinthorn D.
Quinolones and tendon ruptures.
South Med J. 2000 May;93(5):488-91. Review.
PMID: 10832946 [PubMed - indexed for MEDLINE]

Gravlee JR, Hatch RL, Galea AM.
Achilles tendon ruptu a challenging diagnosis.
J Am Board Fam Pract. 2000 Sep-Oct;13(5):371-3. No abstract
available.
PMID: 11001009 [PubMed - indexed for MEDLINE]


2001

Rev Clin Esp. 2001 Sep;201(9):539-40.
Achilles pain and functional impotence in a patient with chronic
obstructive pulmonary disease with pneumonia. Tendon rupture caused by
levofloxacin

Pharm World Sci. 2001 Jun;23(3):89-92.
Fluoroquinolone use and the change in incidence of tendon ruptures in
the Netherlands.
van der Linden PD, Nab HW, Simonian S, Stricker BH, Leufkens HG,
Herings RM.

Mennecier D, Thiolet C, Bredin C, Potier V, Vergeau B, Farret O.
[Acute pancreatitis after treatment by levofloxacin and
methylprednisolone]
Gastroenterol Clin Biol. 2001 Oct;25(10):921-2. French. No abstract
available.
PMID: 11852403 [PubMed - indexed for MEDLINE]

Csizy M, Hintermann B.
[Rupture of the Achilles tendon after local steroid injection. Case
reports and consequences for treatment]
Swiss Surg. 2001;7(4):184-9. German.
PMID: 11515194 [PubMed - indexed for MEDLINE]

Adverse reactions to fluoroquinolones an overview on mechanistic
aspects
De Sarro et al (Current Medicinal Chemistry 2001, 8, 371-384)

Fluoroquinolone use and the change in incidence of tendon rupture in
the Netherlands
Van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)

Tendon disorders attributed to fluoroquinolones; a study on 42
spontaneous reports in the period 1988-1998
Van Der Linden et al (American College of Rheumatology; Arthritis Care
and Research 45; 2001 pages 235-239)

1847 reported tendinopathies December 2001
Tabelle 7
Pharmacovigilance: Meldungen von Tendinopathien im Vergleich zu allen
gemeldeten unerwünschten Arzneimittelwirkungen (UAW), Stand 17.
Dezember 2001.

Meldungen Schweiz (IKS-Datenbank) Welt (WHO-Datenbank)
Tendinopathie alle UAW Tendinopathie alle UAW
Ciprofloxacin 8 (5%) 155 649(2,2%) 29 090
Fleroxacin 9 (1,2 %) 754
Norfloxacin 1 (1%) 91 163 (2,1%) 7536
Ofloxacin 2 (6%) 34 432 (1,8%) 23 990
Levofloxacin 32 (41%) 79 576 (7,8%) 7432
Moxifloxacin 18 (4,5 %) 4030
Source: http://www.saez.ch/pdf/2003/2003-02/2003-02-694.PDF
http://www.saez.ch/pdf/2003/2003-02/2003-02-694.PDF

U.S. ARMED FORCES
Spontaneous Ruptures of the Achilles Tendon, US Armed Forces,
1998-2001
Methods. The Defense Medical Surveillance System was searched to
identify all incident ambulatory visits of active duty servicemembers
with a primary diagnosis of non-traumatic rupture of the achilles
tendon (ICD-9- CM code 727.67) and other tendon ruptures (ICD-9- CM
codes 727.60-727.66, 727.68-727.69) between January 1998 and May 2001.
The most striking finding of this analysis is the sudden and
significant increase in rates of achilles tendon ruptures beginning in
calendar year 2000. The increase was manifested across all Services
and in most demographic subgroups (table 1). Rates
of non-traumatic ruptures of several other tendons also increased
during the period; and increases in ruptures of the rotator cuff were
comparable to those of the achilles tendon.
Source: http://amsa.army.mil/1Msmr/2002/v08_n01.pdf

Nuno Mateo FJ, Noval Menendez J, Suarez M, Guinea O.
[Achilles pain and functional impotence in a patient with chronic
obstructive pulmonary disease with pneumonia. Tendon rupture caused by
levofloxacin]
Rev Clin Esp. 2001 Sep;201(9):539-40. Spanish. No abstract available.
PMID: 11692412 [PubMed - indexed for MEDLINE]

Malaguti M, Triolo L, Biagini M.
Ciprofloxacin-associated Achilles tendon rupture in a hemodialysis
patient.
J Nephrol. 2001 Sep-Oct;14(5):431-2. No abstract available.
PMID: 11730281 [PubMed - indexed for MEDLINE]

Butler MW, Griffin JF, Quinlan WR, McDonnell TJ.
Quinolone-associated tendonitis: a potential problem in COPD?
Ir J Med Sci. 2001 Jul-Sep;170(3):198-9.
PMID: 12120977 [PubMed - indexed for MEDLINE]

Bharani A, Kumar H.
Drug points: Diabetes inspidus induced by ofloxacin.
BMJ. 2001 Sep 8;323(7312):547. No abstract available.
PMID: 11546701 [PubMed - indexed for MEDLINE]

van der Linden et al (Pharmacy World and Science vol 23 no 3 2001 pg
89-92)
The cohort included 46 776 users of fluoroquinolones between 1 July
1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38
had Achilles tendon rupture
source: http://bmj.com/cgi/content/full/324/7349/1306


2002

[No authors listed]
Side effects of levofloxacin.
Prescrire Int. 2002 Aug;11(60):116-7. No abstract available.
PMID: 12199267 [PubMed - indexed for MEDLINE]

Hatori M, Matsuda M, Kokubun S.
Ossification of Achilles tendon--report of three cases.
Arch Orthop Trauma Surg. 2002 Sep;122(7):414-7. Epub 2002 May 03.
PMID: 12228804 [PubMed - indexed for MEDLINE]

Pouzaud F, Rat P, Cambourieu C, Nourry H, Warnet JM.
[Tenotoxic potential of fluoroquinolones in the choice of surgical
antibiotic prophylaxis in ophthalmology]
J Fr Ophtalmol. 2002 Nov;25(9):921-6. French.
PMID: 12515937 [PubMed - indexed for MEDLINE]

Sobel E, Giorgini R, Hilfer J, Rostkowski T.
Ossification of a ruptured achilles tendon: a case report in a
diabetic patient.
J Foot Ankle Surg. 2002 Sep-Oct;41(5):330-4.
PMID: 12400718 [PubMed - indexed for MEDLINE]

wood ML, Schlessinger S.
Levaquin induced acute tubulointerstitial nephritis--two case reports.
J Miss State Med Assoc. 2002 Apr;43(4):116-7. No abstract available.
PMID: 11989200 [PubMed - indexed for MEDLINE]


Fluoroquinolones and risk of Achilles tendon disorders: case-control
study BMJ 2002;324:1306-1307 ( 1 June ) P D van der Linden, researcher
a, M C J M Sturkenboom, assistant professor a, R M C Herings,
associate professor b, H G M Leufkens, professor b, B H Ch Stricker,
professor a.
a Pharmaco-epidemiology Unit, Department of Epidemiology &
Biostatistics and Internal Medicine, Erasmus Medical Centre Rotterdam,
PO Box 1738, 3000 DR Rotterdam, Netherlands, b Department of Pharmaco-
epidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Utrecht, Netherlands

Pai VS, Patel N.
Atypical coronal or sagittal Z ruptures of the achilles tendon: a
report of four cases.
J Foot Ankle Surg. 2002 May-Jun;41(3):183-5.
PMID: 12075907 [PubMed - indexed for MEDLINE]

van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker
BH.
Fluoroquinolones and risk of Achilles tendon disorders: case-control
study.
BMJ. 2002 Jun 1;324(7349):1306-7. No abstract available.
PMID: 12039823 [PubMed - indexed for MEDLINE]

Med Clin (Barc). 2003 Jan 25;120(2):78-9.
Comment on: Med Clin (Barc). 2002 Jun 8;119(1):38-9.
Levofloxacin and bilateral spontaneous Achilles tendon rupture

4 cases of levaquin induced tendintis (orign spansih)
Mica magazine of Chile Issn0034-9887 versi printed
Rev. m. Chilev.130n.11Santiagonov.2002
Rev Méd Chile 2002; 130: 1277-1281
Associated aquiliana Tendinitis to the levofloxacino use:
communication of four cases
Claudius Hoops And, Claudius Flowers W, Sergio Mezzano A.
Levofloxacin associated Achilles

Pedros A, Emilio Gomez J, Angel Navarro L, Tomas A.
[Levofloxacin and acute confusional syndrome]
Med Clin (Barc). 2002 Jun 8;119(1):38-9. Spanish. No abstract
available.
PMID: 12062009 [PubMed - indexed for MEDLINE]


Roberts C, Deliss L.:
Acute rupture of tendo Achillis.
J Bone Joint Surg Br. 2002 May;84(4):620; author reply 620. No
abstract available.
PMID: 12043793 [PubMed - indexed for MEDLINE]

Paffey MD, Faraj AA.
Acute rupture of tendo Achillis.
J Bone Joint Surg Br. 2002 May;84(4):620-1; author reply 621. No
abstract available.
PMID: 12043792 [PubMed - indexed for MEDLINE]

Chhajed PN, Plit ML, Hopkins PM, Malouf MA, Glanville AR.
Achilles tendon disease in lung transplant recipients: association
with ciprofloxacin.
Eur Respir J. 2002 Mar;19(3):469-71.
PMID: 11936524 [PubMed - indexed for MEDLINE]

Greene BL.Physical therapist management of fluoroquinolone-induced
Achilles tendinopathy.
Phys Ther. 2002 Dec;82(12):1224-31.
PMID: 12444881 [PubMed - indexed for MEDLINE]

Breck RW.
"Ciprofloxacin: a warning for clinicians".
Conn Med. 2002 Oct;66(10):635. No abstract available.
PMID: 12448217 [PubMed - indexed for MEDLINE]


2003

Journal of Antimicrobial Chemotherapy (2003) 51, 747-748
DOI: 10.1093/jac/dkg081
Advance Access publication 28 January 2003
Correspondence
Spontaneous Achilles tendon rupture in patients
treated with levofloxacin
L. J. Haddow, M. Chandra Sekhar, V. Hajela and
G. Gopal Rao


Schwalm JD, Lee CH.
Acute hepatitis associated with oral levofloxacin therapy in a
hemodialysis patient.
CMAJ. 2003 Apr 1;168(7):847-8.
PMID: 12668542 [PubMed - indexed for MEDLINE]

Oh YR, Carr-Lopez SM, Probasco JM, Crawley PG.
Levofloxacin-induced autoimmune hemolytic anemia.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1010-3.
PMID: 12841809 [PubMed - indexed for MEDLINE]

Bardin L.
Comments on 'Achilles tendinopathy'.
Man Ther. 2003 Aug;8(3):189; author reply 190-1. No abstract
available.
PMID: 12909446 [PubMed - indexed for MEDLINE]


[No authors listed]
Tendon abnormalities and hypersensitivity of levofloxacin.
Prescrire Int. 2003 Feb;12(63):20. No abstract available.
PMID: 12602391 [PubMed - indexed for MEDLINE]

DY, Song JC, Wang CC.
Anaphylactoid reaction to ciprofloxacin.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1018-23.
PMID: 12841811 [PubMed - indexed for MEDLINE]

[No authors listed]
Fluoroquinolones in ambulatory ENT and respiratory tract infections:
rarely appropriate.
Prescrire Int. 2003 Feb;12(63):26-7.
PMID: 12602405 [PubMed - indexed for MEDLINE]


Khaliq Y, Zhanel GG.
Fluoroquinolone-associated tendinopathy: a critical review of the
literature.
Clin Infect Dis. 2003 Jun 1;36(11):1404-10. Epub 2003 May 20. Review.
PMID: 12766835 [PubMed - indexed for MEDLINE]

Prasad S, Lee A, Clarnette R, Faull R.
Spontaneous, bilateral patellar tendon rupture in a woman with
previous Achilles tendon rupture and systemic lupus erythematosus.
Rheumatology (Oxford). 2003 Jul;42(7):905-6. No abstract available.
PMID: 12826711 [PubMed - indexed for MEDLINE]

Gold L, Igra H.
Levofloxacin-induced tendon ruptu a case report and review of the
literature.
J Am Board Fam Pract. 2003 Sep-Oct;16(5):458-60. Review. No abstract
available.
PMID: 14645337 [PubMed - indexed for MEDLINE]

Schindler C, Pittrow D, Kirch W.
Reoccurrence of levofloxacin-induced tendinitis by
phenoxymethylpenicillin therapy after 6 months: a rare complication of
fluoroquinolone therapy?
Chemotherapy. 2003 May;49(1-2):90-1. No abstract available.
PMID: 12756981 [PubMed - indexed for MEDLINE]

de La Red G, Mejia JC, Cervera R, Llado A, Mensa J, Font J.
Bilateral Achilles tendinitis with spontaneous rupture induced by
levofloxacin in a patient with systemic sclerosis.
Clin Rheumatol. 2003 Oct;22(4-5):367-8. No abstract available.
PMID: 14579169 [PubMed - indexed for MEDLINE]

Tomas ME, Perez Carreras M, Morillasa JD, Castellano G, Solis JA.
[Rupture of the Achilles' tendon secondary to levofloxacin]
Gastroenterol Hepatol. 2003 Jan;26(1):53-4. Spanish. No abstract
available.
PMID: 12525331 [PubMed - indexed for MEDLINE]

Mathis AS, Chan V, Gryszkiewicz M, Adamson RT, Friedman GS.
Levofloxacin-associated Achilles tendon rupture.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):1014-7.
PMID: 12841810 [PubMed - indexed for MEDLINE]

Aros C, Flores C, Mezzano S.[Achilles tendinitis associated to
levofloxacin: report of 4 cases]
Rev Med Chil. 2002 Nov;130(11):1277-81. Spanish.
PMID: 12587511 [PubMed - indexed for MEDLINE]

Shah P.[Do tendon lesions occur during quinolone administration?]
Dtsch Med Wochenschr. 2003 Oct 17;128(42):2214. German. No abstract
available.
PMID: 14562223 [PubMed - indexed for MEDLINE]

Melhus A, Apelqvist J, Larsson J, Eneroth M.
Levofloxacin-associated Achilles tendon rupture and tendinopathy.
Scand J Infect Dis. 2003;35(10):768-70.
PMID: 14606622 [PubMed - indexed for MEDLINE]

Cebrian P, Manjon P, Caba P.
Ultrasonography of non-traumatic rupture of the Achilles tendon
secondary to levofloxacin.
Foot Ankle Int. 2003 Feb;24(2):122-4.
PMID: 12627618 [PubMed - indexed for MEDLINE]

Bernacer L, Artigues A, Serrano A.
[Levofloxacin and bilateral spontaneous Achilles tendon rupture]
Med Clin (Barc). 2003 Jan 25;120(2):78-9. Spanish. No abstract
available.
PMID: 12570920 [PubMed - indexed for MEDLINE]

Haddow LJ, Chandra Sekhar M, Hajela V, Gopal Rao G.
Spontaneous Achilles tendon rupture in patients treated with
levofloxacin.
J Antimicrob Chemother. 2003 Mar;51(3):747-8. No abstract available.
PMID: 12615887 [PubMed - indexed for MEDLINE]

Othmani S, Battikh R, Ben Abdallah N.
[The myo-tendinopathy caused by levofloxacin]
Therapie. 2003 Sep-Oct;58(5):463-5. French. No abstract available.
PMID: 14682197 [PubMed - indexed for MEDLINE]

Gutierrez E, Morales E, Garcia Rubiales MA, Valentin MO.
[Levofloxacin and Achilles tendon involvement in hemodialysis
patients]
Nefrologia. 2003 Nov-Dec;23(6):558-9. Spanish. No abstract available.
PMID: 15002793 [PubMed - indexed for MEDLINE]

Spontaneous Achilles tendon rupture in patients treated with
levofloxacin
L. J. Haddow, M. Chandra Sekhar, V. Hajela and G. Gopal Rao*
Department of Microbiology, University Hospital Lewisham, Lewisham
High Street, London SE13 6LH, UK 2003 The British Society for
Antimicrobial Chemotherapy

Clinical Infectious Diseases 2003;36:1404-1410
2003 by the Infectious Diseases Society of America. All rights
reserved.
Fluoroquinolone-Associated Tendinopathy: A Critical Review of the
Literature
Yasmin Khaliq1 and George G. Zhanel2

J Am Podiatr Med Assoc. 2003 Jul-Aug;93(4):333-5.
Fluoroquinolone therapy and Achilles tendon rupture.
Vanek D, Saxena A, Boggs JM.

Clin Rheumatol. 2003 Dec;22(6):500-1. Epub 2003 Oct 18.
Ciprofloxacin and Achilles' tendon ruptu a causal relationship.

Aten Primaria. 2003 Sep 15;32(4):256
Bilateral Achilles tendinitis as adverse reaction to levofloxacine.

Therapie. 2003 Sep-Oct;58(5):463-5.
The myo-tendinopathy caused by levofloxacin

Reumatismo. 2003 Oct-Dec;55(4):267-9.
Levofloxacin-induced bilateral rupture of the Achilles tendon:
clinical and sonographic findings

Gastroenterol Hepatol. 2003 Jan;26(1):53-4.
Rupture of the Achilles' tendon secondary to levofloxacin

J Antimicrob Chemother. 2003 Mar;51(3):747-8.
Spontaneous Achilles tendon rupture in patients treated with
levofloxacin.

Foot Ankle Int. 2003 Feb;24(2):122-4.
Ultrasonography of non-traumatic rupture of the Achilles tendon
secondary to levofloxacin.

Chemotherapy. 2003 May;49(1-2):90-1.
Reoccurrence of levofloxacin-induced tendinitis by
phenoxymethylpenicillin therapy after 6 months: a rare complication of
fluoroquinolone therapy?

rupture of the Achilles tendon: clinical and sonographic findings]
Reumatismo. 2003 Oct-Dec;55(4):267-9. Italian.
PMID: 14872227 [PubMed - indexed for MEDLINE]

Ann Pharmacother. 2003 Jul-Aug;37(7-8):1014-7.
Levofloxacin-associated Achilles tendon rupture.

Scand J Infect Dis. 2003;35(10):768-70.
Levofloxacin-associated Achilles tendon rupture and tendinopathy.

Levofloxacin-associated Achilles tendon rupture and tendinopathy.
Scand J Infect Dis 2003;35(10):768-70 (ISSN: 0036-5548) Melhus A;
Apelqvist J; Larsson J; Eneroth M Department of Medical
Microbiology, Malmo University Hospital, Malmo, Sweden.
.

Levofloxacin and trovafloxacin inhibition of experimental fracture-
healing. Clin Orthop 2003 Sep;(414):95-100 (ISSN: 0009-921X) Perry
AC; Prpa B; Rouse MS; Piper KE; Hanssen AD; Steckelberg JM; Patel R
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905,
USA.

Levofloxacin-associated Achilles tendon rupture. Ann Pharmacother 2003
Jul-Aug;37(7-8):1014-7 (ISSN: 1060-0280) Mathis AS; Chan V;
Gryszkiewicz M; Adamson RT; Friedman GS Department of Pharmacy
Practice and Administration, Ernest Mario School of Pharmacy, Rutgers,
The State University of New Jersey, Piscataway, NJ, USA.
.

Ultrasonography of non-traumatic rupture of the Achilles tendon
secondary to levofloxacin. Foot Ankle Int 2003 Feb;24(2):122-4 (ISSN:
1071-1007) Cebrian P; Manjon P; Caba P Departamento de
Radiodiagnostico, Hospital Universitario 12 de Octubre, Madrid, Spain.
.

J Am Board Fam Pract. 2003 Sep-Oct;16(5):458-60.
Levofloxacin-induced tendon ruptu a case report and review of the
literature.


2004

Mehra A, Maheshwari R, Case R, Croucher C.
Bilateral simultaneous spontaneous rupture of the Achilles tendon.
Hosp Med. 2004 May;65(5):308-9. No abstract available.
PMID: 15176150 [PubMed - indexed for MEDLINE]

Vergara Fernandez I.
[Muscle and tendon problems as a side-effect of levofloxacine: review
of a case]
Aten Primaria. 2004 Mar 15;33(4):214. Spanish. No abstract available.
PMID: 15023326 [PubMed - indexed for MEDLINE]

Fama U, Irace S, Frati R, de Gado F, Scuderi N.
Is it a real risk to take ciprofloxacin?
Plast Reconstr Surg. 2004 Jul;114(1):267. No abstract available.
PMID: 15220615 [PubMed - indexed for MEDLINE]

Kahn F, Christensson B.
[A rapid development of Achilles tendon rupture following quinolone
treatment]
Lakartidningen. 2004 Jan 15;101(3):190-1. Swedish. No abstract
available.
PMID: 14763088 [PubMed - indexed for MEDLINE]

Long term outcome after Fluoroquinolones tendinopathies
13/01/2004 14:11:07 P-0077
C Guy (1); Y Murat (1); MN Beyens (1); M Ratrema (1); G Mounier (1); M
Ollagnier (1); (1) Centre de Pharmacovigilance, Hôpital Bellevue - CHU
St-Etienne, Sant-Etienne

Levofloxacin-induced bilateral Achilles tendon ruptu a case report
and review of the literature. J Orthop Sci 2004;9(2):186-90 (ISSN:
0949-2658) Kowatari K; Nakashima K; Ono A; Yoshihara M; Amano M; Toh
S Department of Orthopaedic Surgery, Aomori Rosai Hospital, 1
Minamigaoka, Shirogane-machi, Hachinohe 031-8551, Japan.

Pharmacol Exp Ther. 2004 Jan;308(1):394-402. Epub 2003 Oct 20. In
vitro discrimination of fluoroquinolones toxicity on tendon cells:
involvement of oxidative stress.

Hosp Med. 2004 May;65(5):308-9.
Bilateral simultaneous spontaneous rupture of the Achilles tendon.
Mehra A, Maheshwari R, Case R, Croucher C.

Therapie. 2004 Nov-Dec;59(6):653-5.
Ofloxacin-induced achilles tendinitis in the absence of a
predisposition

An Med Interna. 2004 Mar;21(3):154.
Achilles bilateral tendonitis and levofloxacin

J Orthop Sci. 2004;9(2):186-90.
Levofloxacin-induced bilateral Achilles tendon ruptu a case report
and review of the literature.

Scand J Infect Dis. 2004;36(4):315-6.
Recurrent tendinitis after treatment with two different
fluoroquinolones.

Joint Bone Spine. 2004 Nov;71(6):586-7. Related Articles, Links
Rupture of multiple tendons after levofloxacin therapy.
Braun D, Petitpain N, Cosserat F, Loeuille D, Bitar S, Gillet P,
Trechot P.
Pneumology Department, Maillot Hospital, 54150 Briey, France.

Aten Primaria. 2004 Mar 15;33(4):214.
Muscle and tendon problems as a side-effect of levofloxacine: review
of a case

Kowatari K, Nakashima K, Ono A, Yoshihara M, Amano M, Toh .
Levofloxacin-induced bilateral Achilles tendon ruptu a case report
and review of the literature.
J Orthop Sci. 2004;9(2):186-90. Review.
PMID: 15045551 [PubMed - indexed for MEDLINE]

Gomez Rodriguez N, Ibanez Ruan J, Gonzalez Perez M.
[Achilles bilateral tendonitis and levofloxacin]
An Med Interna. 2004 Mar;21(3):154. Spanish. No abstract available.
PMID: 15043504 [PubMed - indexed for MEDLINE]

Filippucci E, Farina A, Bartolucci F, Spallacci C, Busilacchi P,
Grassi W.[Levofloxacin-induced bilateral

Burkhardt O, Kohnlein T, Pap T, Welte T.
Recurrent tendinitis after treatment with two different
fluoroquinolones.
Scand J Infect Dis. 2004;36(4):315-6.
PMID: 15198194 [PubMed - indexed for MEDLINE]


2005

Toxicology. 2005 May 9
Fluoroquinolones cause changes in extracellular matrix, signalling
proteins, metalloproteinases and caspase-3 in cultured human tendon
cells.
Sendzik J, Shakibaei M, Schafer-Korting M, Stahlmann R.

Arch Orthop Trauma Surg. 2005 Mar;125(2):124-6. Epub 2005 Jan 12.
Missed Achilles tendon rupture due to oral levofloxacin: surgical
treatment and result.

An Med Interna. 2005 Jan;22(1):28-30.
Partial bilateral rupture of the Achilles tendon associated to
levofloxacin

Expert Opin Drug Saf. 2005 Mar;4(2):299-309.
Fluoroquinolones and tendon disorders.
Melhus A.

Toxicology. 2005 May 9
Fluoroquinolones cause changes in extracellular matrix, signalling
proteins, metalloproteinases and caspase-3 in cultured human tendon
cells.
Sendzik J, Shakibaei M, Schafer-Korting M, Stahlmann R.
Institute of Clinical Pharmacology and Toxicology, Department of
Toxicology, Charite-Universitatsmedizin Berlin, Campus Benjamin
Franklin, Garystr. 5, 14195 Berlin, Germany; Institute of Anatomy,
Department of Cell and Neurobiology, Charite-Universitatsmedizin
Berlin, Campus Benjamin Franklin, Konigin-Luise-Str. 15, 14195 Berlin,
Germany; Musculoskeletal Research Group, Institute of Anatomy, Ludwig-
Maximilian-Universitat Munich, Pettenkoferstr. 11, 80336 Munich,
Germany.

AUSTRALIA
THE ACHILLES HEEL OF FLUOROQUINOLONES
One of the more unusual adverse reactions known to be associated with
the fluoroquinolone antibiotics is the occurrence of tendinitis. This
is a serious effect since it may progress to tendon rupture with many
weeks of disability as a result. Over 200 cases have been reported in
the literature with the majority from France. Most members of the
class including ciprofloxacin, enoxacin, ofloxacin, and norfloxacin
have been implicated. The Achilles tendon is most often involved.
In Australia, there have been 25 reports of tendinitis in association
with fluoroquinolones. Most (22) have been with ciprofloxacin and the
other three with norfloxacin. The majority of the patients involved
were elderly, ranging in age from 46 to 91 (median 69) years and the
sex distribution was equal. For ciprofloxacin, daily dosages ranged
from 750 mg to 2250 mg although most (13) patients were taking 1000 mg
daily. For norfloxacin, all three patients were taking the usual dose
of 800 mg daily. Time to onset ranged from the same day that the drug
was commenced (in two patients) to two months although in 13 of the 24
reports which provided the information, the reaction occurred within
the first week. Almost all (23) of the reports specified the Achilles
tendon as the site of the tendinitis. Tendinitis was described as
bilateral in 11 cases. Only 8 patients had recovered at the time the
report was submitted and the other patients were being treated with
rest and/or physiotherapy. There have been no reports of tendon
rupture in Australia although in one severe case, the patient required
a plaster cast up to the mid thigh.
A number of risk factors have been identified with regard to this
adverse reaction. These include old age, renal dysfunction, and
concomitant corticosteroid therapy. Of the patients reported to ADRAC,
72% were older than 60 years. Nine of these patients were taking
corticosteroids as were three of the younger patients.
Prescribers are reminded that tendinitis, especially involving the
Achilles tendon, is a rare adverse effect of the fluoroquinolones. It
is more likely to occur in association with the risk factors referred
to above. The antibiotic should be withdrawn immediately to reduce the
risk of tendon rupture.


DUTCH
Fluoroquinolones have been associated with tendon disorders, usually
during the first month of treatment,1-5 but the epidemiological
evidence is scanty. We did a nested case-control study among users of
fluoroquinolones in a large UK general practice database to study the
association with Achilles tendon disorders.

Participants, methods, and results

We obtained data from the IMS Health database (UK MediPlus), which
contains data from general practice on consultations, morbidity,
prescriptions, and other interventions in a source population of 1-2
million inhabitants. The base cohort consisted of all patients aged 18
years or over who had received a fluoroquinolone. We excluded people
with a history of Achilles tendon disorders, cancer, AIDS, illicit
drug use, or alcohol misuse. We identified potential cases by
reviewing patient profiles and clinical data and excluded tendon
disorders due to direct trauma. We randomly sampled a group of 10 000
control patients from the study cohort.

We defined four categories of exposure to fluoroquinolones: current
use, recent use, past use, and no use. We defined current use as when
the tendon disorder occurred in the period between the start of the
fluoroquinolone treatment and the calculated end date plus 30 days,
recent use as when the calculated end date was between 30 and 90 days
before the occurrence of the disorder, and past use as when the
calculated end date was more than 90 days before the occurrence of the
disorder. We used unconditional logistic regression analysis to
calculate adjusted relative risks and 95% confidence intervals for
Achilles tendon disorders, using the no use group as the reference. We
adjusted for age, sex, number of visits to the general practitioner,
use of corticosteroid, calendar year, obesity, and history of
musculoskeletal disorders.

The cohort included 46 776 users of fluoroquinolones between 1 July
1992 and 30 June 30 1998, of whom 704 had Achilles tendinitis and 38
had Achilles tendon rupture. Four hundred and fifty three (61%) of the
cases were women, and the mean age was 56 years. Cases visited the
general practitioner significantly more often than did controls (mean
20 v 17). Cases and controls were similar with respect to indications
for use of fluoroquinolone. Age, number of visits to the general
practitioner in the previous 18 months, gout, obesity, and use of
corticosteroid were determinants of Achilles tendon disorders. The
adjusted relative risk of Achilles tendon disorders with current use
of fluoroquinolones was 1.9 (95% confidence interval 1.3 to 2.6). The
risk for recent and past use was similar to that for no use. The
relative risk with current use was 3.2 (2.1 to 4.9) among patients
aged 60 and over and 0.9 (0.5 to 1.6) among patients aged under 60
(table). In patients aged 60 or over, concurrent use of
corticosteroids and fluoroquinolones increased the risk to 6.2 (3.0 to
12.8).

Relative risk of Achilles tendon disorders associated with use of
fluoroquinolones according to age
Current exposure to fluoroquinolones increases the risk of Achilles
tendon disorders. This finding is in agreement with a smaller study,
in which we found an association between tendinitis and
fluoroquinolones.5 Our results indicate that this adverse effect is
relatively rare, with an overall excess risk of 3.2 cases per 1000
patient years. The effect seems to be restricted to people aged 60 or
over, and within this group concomitant use of corticosteroids
increased the risk substantially. The proportion of Achilles tendon
disorders among patients with both risk factors that is attributable
to their interaction was 87%. Although the mechanism is unknown, the
sudden onset of some tendinopathies, occasionally after a single dose
of a fluoroquinolone, suggests a direct toxic effect on collagen
fibres. Prescribers should be aware of this risk, especially in
elderly people taking corticosteroids.

Acknowledgments
We acknowledge the cooperation of IMS Health United Kingdom.
Contributors: PDvdL, MCJMS, and BHChS formulated the design of the
study. PDvdL carried out the analyses. PDvdL, MCJMS, and BHChS wrote
the paper, and RMCH and HGML edited it. BHChS and HGML are guarantors
for the paper.

Funding:
Dutch Inspectorate for Health Care.

Competing interests:
MCJMS is a consultant for Lundbeck (France) and Beaufour (UK) and has
previously been a consultant for Pfizer (USA), Roche (Switzerland),
and Novartis Consumerhealth (Switzerland). MCJMS is responsible for
research conducted with the integrated primary care information
database in the Netherlands, which is supported by project specific
grants from GlaxoSmithKline, AstraZeneca, Merck Sharp & Dohme,
Pharmacia & Upjohn, Bristol-Myers Squibb, Eli Lilly, Wyeth, and
Yamanouchi. MCJMS has conducted research projects on use of
antibiotics for Merck & Co (USA) and Bayer (Italy).

This is far from being an all inclusive list of such medical journal
entries and other such main stream documentation. Starting in 1965
and ending in 2005, almost forty years worth of such reports and the
treating physician as well as the patient have no prior knowledge
concerning such events. Perhaps you missed these two hundred plus
published reports.

Peripheral Neuropathy

Orofacial dyskinesia after ofloxacin treatment. Reversible orofacial
dyskinesia after ofloxacin treatment.
De Bleecker JL, Vervaet VL, De Sarro A.
Department of Neurology, Gent University Hospital, Ghent, Belgium.



Cipro Induced Psychosis
A case of ciprofloxacin-induced acute polymorphic psychosis with a
distinct deficit of the executive functions
Grimm, Dr. Oliver and Alm, Dr. Barbara (2005)

Prolonged Electroconvulsive Therapy Seizure in a Patient Taking
Ciprofloxacin. Journal of ECT. 21(1):43-44, March 2005.
Kisa, Cebrail MD; Yildirim, Sema G MD; Aydemir, Cigdem MD; Cebeci,
Sevsen MD; Goka, Erol MD
"...the extended seizure in this patient is thought to be related to
ciprofloxacin..."

Antimicrobial-induced mania (antibiomania): a review of spontaneous
reports. Abouesh A, Stone C, Hobbs WR.

Gatifloxacin Precipitation of Psychosis in Alzheimer Disease
Roy R. Reeves, D.O., Ph.D.

Delirium Associated With Gatifloxacin
C. Loraine Sumner, B.A., and Richard L. Elliott, M.D., Ph.D.,
F.A.P.A., Macon, Ga.

Ciprofloxacin-induced oral facial dyskinesia in a patient with normal
liver and renal function.
Hosp Med. 2000 Feb;61(2):142-3. Lee CH, Cheung RT, Chan TM.
Department of Medicine, University of Hong Kong, Queen Mary Hospital,
Hong Kong.
Toxicol Appl Pharmacol. 1991 Nov;111(2):255-62. Related Articles,
Links

Ciprofloxacin-induced chorea.
Azar S, Ramjiani A, Van Gerpen JA.
Mov Disord. 2005 Feb 28; [Epub ahead of print]
PMID: 15739219 [PubMed - as supplied by publisher]

Mechanisms of pefloxacin-induced pain.
Bull Exp Biol Med. 2004 Apr;137(4):336-8. Kukushkin ML, Igonkina SI,
Guskova TA. Laboratory of Pathophysiology of Pain, Institute of
General Pathology and Pathophysiology, Russian Academy of Medical
Sciences, Moscow.

Generalized seizure and toxic epidermal necrolysis following
levofloxacin exposure.
Christie MJ, Wong K, Ting RH, Tam PY, Sikaneta TG. University of
Toronto, Nephrology Associates, Scarborough, Ontario, Canada, and
Scarborough General Hospital, Scarborough.
[General pharmacology of T-3761, a new oral quinolone antibacterial
agent (2). Effect on the respiratory and cardiovascular systems,
autonomic nervous system and other functions]
[Article in Japanese] Furuhata K, Hiraiwa T, Terashima N, Arai H, Ono
S, Hashiba K, Maekawa M, Kitamura K, Nakada Y, Mori Y, et al.
Research Laboratories, Toyama Chemical Co., Ltd.

The Cohen Report
The Annals of Pharmacotherapy 2001 December, Volume 35 1
Peripheral Neuropathy Associated with Fluoroquinolones
Dr. Jay S Cohen
www.theannals.com

Peripheral neuropathy has been reported in patients receiving
quinolones. (Package insert warning updates, July 2004)

Peripheral Neuropathy Associated With Cipro November 2, 2001 New York

Peripheral neuropathy associated with Pefloxacin;

1990 Chan PC, Cheng IK, Chan MK, Wong WT. Br J Clin Pract. 1990 Dec;
44(12):564-7.
B. 1995 Vial T, Chauplannaz G, Brunel P, Leriche B, Evreux JC. 1995
[Exacerbation of myasthenia gravis by pefloxacin]
Rev Neurol (Paris). 1995 Apr;151(4):286-7. French.
PMID: 7481384 [PubMed - indexed for MEDLINE]
Sparfloxacin:

1992 Hinyokika Kiyo. 1992 Jan;38(1):121-8.
[Clinical and bacteriological study of sparfloxacin on bacterial
prostatitis]
[Article in Japanese]
*Suzuki K, Horiba M, Naide Y, Shinoda M, Hibi H.
Department of Urology, Hiratsuka City Hospita

Ciprofloxacin:

A. 1988 J Antimicrob Chemother. 1988 Aug;22(2):221-8.
PMID: 3053554 [PubMed - indexed for MEDLINE]

B. 1988 Moore B, Safani M, Keesey J.
Possible exacerbation of myasthenia gravis by ciprofloxacin.

C. Lancet. 1988 Apr 16;1(8590):882. No abstract available.
PMID: 2895386 [PubMed - indexed for MEDLINE]

D. 1988 J Antimicrob Chemother. 1988 Aug;22(2):221-8. No Authors
listed. Therapy of acute and chronic gram negative osteomyelitis with
Ciprofloxacin, Report from a Swedish Study Group
Ten adverse events related to ciprofloxacin treatment were observed in
nine patients; two phototoxic reactions, two cases of impaired colour
vision, and one each of exanthema, abdominal pain, malaise, drug
fever, peripheral neuropathy and eosinophilia.

E. 1990 Mumford CJ, Ginsberg L. 1990
Ciprofloxacin and myasthenia gravis.

F. BMJ. 1990 Oct 6;301(6755):818. No abstract available.
PMID: 2224281 [PubMed - indexed for MEDLINE]

G. 1992 Maddix DS, Stefani A. 1992
Comment: Myasthenia gravis and ciprofloxacin.
Ann Pharmacother. 1992 Feb;26(2):265. No abstract available.
PMID: 1554947 [PubMed - indexed for MEDLINE]

H. 1993 Rollof J, Vinge E. Ann Pharmacother. 1993 Sep;27(9):1058-9
Neurologic adverse effects during concomitant treatment with
Ciprofloxacin, NSAIDS and chloriquine, possible drug interaction.
"After indomethacin was reintroduced, the patient developed signs and
symptoms of peripheral neuropathy, which partially subsided when
ciprofloxacin was discontinued.

I. 1993 Neurologic adverse effects during concomitant treatment with
ciprofloxacin, NSAIDS, and chloroquine: possible drug interaction.Ann
Pharmacother 1993 Sep;27(9):1058-9.
PMID: 8219437 [PubMed - indexed for MEDLINE]

J. 1994 Singh J, Agarwal AK, Sudrania SP. 1994
Extrapyramidal syndrome following ciprofloxacin treatment.
Indian Pediatr. 1994 May;31(5):608-9. No abstract available.
PMID: 7875902 [PubMed - indexed for MEDLINE]

K. 1995 Zehnder D, Hoigne R, Neftel KA, Sieber R. Painful dysaesthesia
with ciprofloxacin. British Medical Journal. 1995 Nov 4;311(7014):
1204. "One case of peripheral neuropathy has been reported3 We report
two cases of generalised painful dysaesthesia due to ciprofloxacin, a
reaction not previously associated with this particular
fluoroquinolone

L. 1996 Hedenmalm K, Spigset O.
Peripheral sensory disturbances related to treatment with
fluoroquinolones.
J Antimicrob Chemother. 1996 Apr;37(4):831-7.
PMID: 8722551 [PubMed - indexed for MEDLINE] ( see below)

M. 1996 Roquer J, Cano A, Seoane JL, Pou Serradell A 1996
Myasthenia gravis and ciprofloxacin.
Acta Neurol Scand. 1996 Dec;94(6):419-20. No abstract available.
PMID: 9017031 [PubMed - indexed for MEDLINE]

N. PMID: 8865032 [PubMed - indexed for MEDLINE] Pastor P, Moitinho E,
Elizalde I, Cirera I, Tolosa E. Reversible oral-facial dyskinesia in a
patient receiving ciprofloxacin hydrochloride.
Ofloxacin:

A. 1993 Schmidt S, Cordt-Schlegel A, Heitmann R.
Guillain-Barre syndrome during treatment with ofloxacin.

B. J Neurol. 1993 Sep;240(8):506-7. No abstract available.
PMID: 8263558 [PubMed - indexed for MEDLINE]

C. 1993 Azevedo E, Ribeiro JA, Polonia J, Pontes C. 1993
Probable exacerbation of myasthenia gravis by ofloxacin.

D. J Neurol. 1993 Sep;240(8):508. No abstract available.
PMID: 8263560 [PubMed - indexed for MEDLINE]

Moxifloxacin:

A. 2002 Canadian Adverse Drug Reaction Newsletter, Volume 12, Issue 4,
October 2002

B. Optic Neuritis Moxifloxacin (Avelox)
2002 - Canadian Family Physician Nov 2002 -http://www.cfpc.ca/cfp/2002/
Nov/vol48-nov-critical-2.asp

C. 2001 Canadian warnings for PN on Tequin and Avelox Ottawa
labeling. . Gatifloxacin. (Tequin(R)) Fluoroquinolone antibiotic.
Product monograph. Ottawa, Ont: Bristol-Myers Squibb Canada Inc; 2001.

D. Moxifloxacin hydrochloride (Avelox(R)). Fluroquinolone antibiotic.
2000 Product monograph. Ottawa, Ont: Bayer Inc; 2000. Adverse effects.
Gatifloxacin and moxifloxacin have tolerability profiles similar to
other fluoroquinolones. Adverse effects include gastrointestinal upset
(nausea, diarrhea, vomiting, and abdominal pain), headache, and
dizziness. Adverse effects reported since marketing are ventricular
tachycardia, renal failure, peripheral neuropathy, myositis, and
tendonitis.

20. Peripheral neuropathy associated with Avelox and Tequin 2002
What they say about Tequin and Avelox in Canada:
"Adverse effects. Gatifloxacin and Moxifloxacin have tolerability
profiles similar to other fluoroquinolones. Adverse effects include
gastrointestinal upset (nausea, diarrhea, vomiting, and abdominal
pain), headache, and dizziness. Adverse effects reported since
marketing are ventricular tachycardia, renal failure, peripheral
neuropathy, myositis, and tendonitis.26,27 26. Gatifloxacin. (Tequin(R))
Fluoroquinolone antibiotic. Product monograph.
Ottawa, Ont: Bristol-Myers Squibb Canada Inc; 2001.
Moxifloxacin hydrochloride (Avelox(R)). Fluroquinolone antibiotic.
Product monograph. Ottawa, Ont: Bayer Inc; 2000. "
http://www.cfpc.ca/cfp/2002/Nov/vol4...critical-2.asp

21. Peripheral sensory disturbances related to treatment with
fluoroquinolones. J Antimicrob Chemother 1996 Apr;37(4):831-7
Hedenmalm K, Spigset O.
Division of Clinical Pharmacology, Norrland University Hospital,
Sweden.

22. Levofloxacin-induced-neurological adverse events such as
convulsion, involuntary movement (tremor, myoclonus and chorea like),
visual hallucination in two elderly patients
Nippon Ronen Igakkai Zasshi. 1999 Mar;36(3):213-7.

23. Levofloxacin-induced delirium.
Clin Neurol Neurosurg. 2005 Feb;107(2):158-9.

24. Effects of fluoroquinolones on the locomotor activity in
rats
Thiel, R.; Metzner, S.; Gericke, C.; Rahm, U.; Stahlmann, R.
ARCHIVES OF TOXICOLOGY
2001; VOL 75; PART 1
36-41

25. The mechanism by which the fluorinated quinolones produce central
nervous system effects is unknown. Assessment of the effects of
ciprofloxacin and nalidixic acid on cerebral blood flow and metabolism
in healthy subjects by positron emission tomography.
Bednarczyk EM, Adler LP, Remler B, Goyer P, Wiznitzer M, Leisure GP,
Little D, Miraldi F.
Department of Medicine, Case Western Reserve University School of
Medicine, Cleveland, Ohio.


26. Neuropsychiatric manifestations and quinolones. Apropos of a case
[Article in French]
Rampa S, Caroli F.
l'Hopital Sainte-Anne, Paris.

27. Seizures Associated with Fluoroquinolones
The Annals of Pharmacotherapy: Vol. 36, No. 7, pp. 1162-1167.
Janine M Kushner, Howard J Peckman, and Clyde R Snyder

28. Peripheral neuropathy associated with fluoroquinolones
Lancet. 1992 Jul 11;340(8811):127. No abstract available.
PMID: 1352007; UI: 92310033
Drug Saf 1991 Jul-Aug;6(4):302-14
Prevention and management of drug-induced peripheral neuropathy.
Olesen LL, Jensen TS
Department of Neurology, Aalborg Hospital, Denmark.

29. Update on Drugs that May Cause or Exacerbate Myasthenia Gravis
McNamara
David R.P. Guay

30. CNS adverse effects are known to occur relatively commonly
with some fluoroquinolones
Lode H
Department of Chest and Infectious Diseases, City Hospital
Berlin-H-Heckeshorn, Berlin, Germany.

31. The symptoms and possible risk factors of peripheral
sensory disturbances related to
fluoroquinolones
Hedenmalm K, Spigset O
Division of Clinical Pharmacology, Norrland University Hospital,
Sweden.

32. Seizures Associated with Fluoroquinolones
The Annals of Pharmacotherapy: Vol. 36, No. 7, pp. 1162-1167.
Janine M Kushner, Howard J Peckman, and Clyde R Snyder

33. Psychotic reactions during administration of quinolones
Ned Tijdschr Geneeskd. 1994 May 21;138(21):1080-2.
[Article in Dutch]

34. Neurochemical studies on quinolone antibiotics: effects on
glutamate, GABA and adenosine
systems in mammalian CNS.
Pharmacol Toxicol. 1989 May;64(5):404-11. Related Articles, Links
Dodd PR, Davies LP, Watson WE, Nielsen B, Dyer JA, Wong LS, Johnston
GA.
Department of Pharmacology, University of Sydney, N.S.W., Australia.

35. Ciprofloxacin-caffeine: a drug interaction established
using in vivo and in vitro investigations.
Am J Med. 1989 Nov 30;87(5A):89S-91S. Related Articles, Links
Harder S, Fuhr U, Staib AH, Wolff T.
Department of Clinical Pharmacology, University Hospital, Frankfurt,
Federal Republic of Germany.

36. Potential neurologic toxicity related to ciprofloxacin
DICP, The Annals of Pharmacotherapy: Vol. 24, No. 2, pp. 138-140.
MT Schwartz and JF Calvert

37. Quinolone toxicity: methods of assessment.
Am J Med. 1991 Dec 30;91(6A):35S-37S.
Patterson DR.
Drug Safety Evaluation, Abbott Laboratories, Abbott Park, Illinois
60064.

38. Possible gatifloxacin-induced seizure.
Quigley CA, Lederman JR.
Department of Pharmacy Practice, College of Pharmacy, Midwestern
University Chicago, Downers Grove, IL 60515-1235, USA.


39. Adverse events associated with pyrazinamide and levofloxacin in
the treatment of latent multidrug-resistant tuberculosis
Tina Papastavros, Lisa R. Dolovich, Anne Holbrook, Lori Whitehead, and
Mark Loeb

40. Quinolone Induced Psychosis

A. The Annals of Pharmacotherapy: Vol. 26, No. 7, pp. 930-931.
Ciprofloxacin-induced psychosis RR Reeves

B. Enferm Infecc Microbiol Clin. 1998 Jan;16(1):42. [Ciprofloxacin
and acute psychosis] [Article in Spanish] Zabala S, Gascon A,
Bartolome C, Castiella J, Juyol M.

C. Eur Psychiatry. 2003 Aug;18(5):262-3. Ciprofloxacin-induced acute
psychosis in a patient with multidrug-resistant tuberculosis.Norra C,
Skobel E, Breuer C, Haase G, Hanrath P, Hoff P. Department of
Psychiatry and Psychotherapy, University Aachen, Pauwelsstrasse 30,
52074 Aachen, Germany.

D. Arch Ophthalmol. 2002 May;120(5):665-6. Acute psychosis following
the use of topical ciprofloxacin. Tripathi A, Chen SI, O'Sullivan S.
Birmingham and Midland Eye Hospital, City Hospital, Dudley Road,
Birmingham B18 7QU, England.

E. Sir, We would like to caution against the use of ciprofloxacin with
non-steroidal anti-inflammatory ...ARL MEDFORD, AJ FRANCE - rcpe.ac.uk

F. ... PSYCHOSIS DUE TO CIPROFLOXACIN AND DICLOFENAC COMBINATION Sir,
We would like to caution against the use of ciprofloxacin with non-
steroidal anti-inflammatory ... http://www.rcpe.ac.uk/publications/a...4_1/Letter.pdf

G. Am J Geriatr Psychiatry 11:470-471, August 2003 Letter
Gatifloxacin Precipitation of Psychosis in Alzheimer Disease Roy R.
Reeves, D.O., Ph.D.

H. Psychother Psychosom. 2001 Jan-Feb;70(1):58-9. Depression or
hypoactive delirium? A report of ciprofloxacin-induced mental disorder
in a patient with chronic obstructive pulmonary disease. Grassi L,
Biancosino B, Pavanati M, Agostini M, Manfredini R.

I. Am J Med. 1991 Apr;90(4):528-9. Acute psychoses associated with the
use of ciprofloxacin and trimethoprim-sulfamethoxazole. McCue JD,
Zandt JR. Tufts University School of Medicine, Boston, Massachusetts.

J. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. Antimicrobial-
induced mania (antibiomania): a review of spontaneous reports. Abouesh
A, Stone C, Hobbs WR. Southern Virginia Mental Health Institute,
Danville, VA 24541, USA.

K. CASE REPORTS
JM Kushner, HJ Peckman, CR Snyder - Ann Pharmacother, 2001 -
theannals.com
.... such as headaches, dizziness, tremor, confu- sion, psychosis, and
seizures. ... two cases
of seizures following administration of levofloxacin and
ciprofloxacin. ...
Clinical features, diagnosis, and management of multiple drug-
resistant tuberculosis since 2002
F Drobniewski, Y Balabanova, R Coker - Current Opinion in Pulmonary
Medicine, 2004 - co-pulmonarymedicine.com
.... These are all safe agents but can produce hepatitis, and a rare
case of ciprofloxacin
acute psychosis has been reported in the management of an MDRTB case
[34 ...

48. Generalized seizure and toxic epidermal necrolysis following
levofloxacin exposure.
Christie MJ, Wong K, Ting RH, Tam PY, Sikaneta TG.
University of Toronto, Nephrology Associates, Scarborough, Ontario,
Canada, and Scarborough General Hospital, Scarborough.

Additional References

The following citations have no abstract. The full text can be
purchased from the links provide or by contacting the author or the
publication cited:

1. Arch Intern Med. 2001 Oct 8;161(18):2261-2.
Myoclonus and generalized seizures associated with gatifloxacin
treatment.
Marinella MA.
Dayton, Ohio.
http://archinte.ama-assn.org/cgi/con...ll/161/18/2261

Additional Research from PubMed/Medline

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2 Skretkowicz J, Gondko A.[Fluoroquinolones interactions with
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3 Hori S, Kizu J, Kawamura M.Effects of anti-inflammatory drugs on
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4 [No authors listed]Mania induced by antimicrobial agents: mainly
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7 Kushner JM, Peckman HJ, Snyder CR.Seizures associated with
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8 Melvani S, Speed BR.Alatrofloxacin-induced seizures during slow
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14 Feinberg SS.Fluoroquinolone-induced depression.
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15 Ross DL, Riley CM.Dissociation and complexation of the
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16 Salm EF, Egberts AC, Maartense E, Hart W, Stricker BH.[Psychotic
reactions during administration of quinolones]
Ned Tijdschr Geneeskd. 1994 May 21;138(21):1080-2. Dutch.
PMID: 8202181 [PubMed - indexed for MEDLINE]

17 De Sarro A, Zappala M, Chimirri A, Grasso S, De Sarro
GB.Quinolones potentiate cefazolin-induced seizures in DBA/2 mice.
Antimicrob Agents Chemother. 1993 Jul;37(7):1497-503.
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18 Reeves RR.Ciprofloxacin-induced psychosis.
Ann Pharmacother. 1992 Jul-Aug;26(7-8):930-1.
PMID: 1504404 [PubMed - indexed for MEDLINE]

19 Rampa S, Caroli F.[Neuropsychiatric manifestations and
quinolones. Apropos of a case]
Encephale. 1991 Nov-Dec;17(6):511-4. French.
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20 Motomura M, Kataoka Y, Takeo G, Shibayama K, Ohishi K, Nakamura
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6 Harder S, Fuhr U, Staib AH, Wolff T.Ciprofloxacin-caffeine: a
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7 Bowie WR, Willetts V, Jewesson PJ.Adverse reactions in a dose-
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(article in which Bayer admits CNS adverse reactions)

Additional Resources
http://www.remcomp.fr/asmanet/bira-95.html
http://www.urmc.rochester.edu/gebs/f...ohn_Hansen.htm
http://www.sobs.soton.ac.uk/staff/hp.html
http://www.soton.ac.uk/~cig/
http://www.dartmouth.edu/dms/mdphd/c.../section3.html
http://neuroscience.nih.gov/Lab.asp?Org_ID=191


So I guess in your reading you overlooked these studys as well. What
exactly is this "data" that you are referring to that contradicts
these three hundred or so studies I have provided you all ready? I
got 3,700 more if you care to have me post each and every one of them.