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• W2916848415 abstract "To the Editor: I read with interest the article by Kabbani and colleagues1 on outpatient antibiotic prescribing patterns between 2011 and 2014 among older adults in the United States. Among the findings of this study were that fluoroquinolones were the most commonly prescribed outpatient antibiotics, accounting for 22% of all prescribed antibiotics. In recent years, there have been a number of warnings issued about the use of fluoroquinolones, which may be particularly relevant to the geriatric population. Among the black box warnings (BBWs) for the fluoroquinolone class is the development of disabling and potentially irreversible tendonitis and tendon rupture, peripheral neuropathy, and central nervous system (CNS) effects, which include both psychiatric adverse reactions and CNS adverse reactions.2-6 The tendonitis and tendon rupture, which can occur bilaterally, may involve the Achilles tendon, rotator cuff, or upper extremities. This adverse effect can occur at any time—from hours after initiating treatment up to several months following the discontinuation of therapy. Risk of tendonitis/tendon rupture is increased in those older than 60 years, in those on corticosteroids, and in renal, cardiac, or lung transplant survivors. The chances of tendon damage are heightened in those engaging in strenuous physical activity, those with renal insufficiency, or those with previous tendon disorders, including rheumatoid arthritis.2-7 The peripheral neuropathy associated with fluoroquinolones consists of either a sensory or a sensorimotor axonal polyneuropathy that affects small and/or large axons. This neuropathy may manifest as paresthesias, hypoesthesias, dysesthesias, or weakness. It can begin shortly after initiating therapy, and it may be irreversible.2-7 Psychiatric adverse reactions, which can occur after the first dose, can include toxic psychosis, psychotic reactions that may lead to suicidal ideas, thoughts, or hallucinations, paranoia or suicide, depression, self-harm, anxiety, agitation, nervousness, confusion, delirium, insomnia, nightmare, or memory impairment. The CNS adverse reactions may include seizures, increased intracranial pressure, dizziness, and tiredness. Caution is advised when administering fluoroquinolones to patients with a seizure disorder or those who are receiving other epileptogenic medications.2-7 Therapy should be discontinued immediately if any of these adverse effects occur. Additional BBWs include that fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis. Fluoroquinolones should not be used as first-line agents for the treatment of acute exacerbations of chronic bronchitis or acute uncomplicated cystitis due to their adverse event profile.2-7 Hypoglycemic coma has also been associated with the use of fluoroquinolones.8 In December 2018, the US Food and Drug Administration issued an additional warning that fluoroquinolones may increase the occurrence of aortic dissections as well as cause the rupture of preexisting aortic aneurysms. Patients most at risk include those with peripheral atherosclerotic vascular disease, hypertension, and genetic conditions, such as Marfan syndrome or Ehlers-Danlos syndrome, and older people. If patients report sudden, constant pain in the stomach, chest, or back, therapy should immediately be discontinued and emergency assistance should be sought.9 Given the seriousness of the adverse events associated with the fluoroquinolones, maybe it is time to rethink their place in the care of the older adult. Financial Disclosure: None. Conflict of Interest: The author has no conflicts of interest to report. Author Contributions: D.M. Lisi is the full author. Sponsor's Role: None." @default.
• W2916848415 created "2019-03-02" @default.
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• W2916848415 date "2019-02-23" @default.
• W2916848415 modified "2023-10-16" @default.
• W2916848415 title "Outpatient Antibiotic Prescribing for Older Adults in the United States: 2011 to 2014" @default.
• W2916848415 cites W2891903826 @default.
• W2916848415 doi "https://doi.org/10.1111/jgs.15831" @default.
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