Antibiotics and side effects
Some BIO230 students might think that I am a bit alarmist with my dire warnings of the coming catastrophe of untreatable infectious, which is an almost certain outcome due to the use and overuse of antibiotics. From the New York Times comes an indication that these medicines bring additional problems. A recent publication in the Journal of the American Medical Association has found that a very popular class of antibiotics, the fluoroquinolones, appear to be associated with a large number of very serious side effects. In 2011 alone, over 2000 lawsuits were filed in this country by patients who had side effects after taking one of these drugs.
The fluoroquinolones are a class of synthetic antimicrobials, first characterized in the 1960’s during an organic synthesis reaction to produce chloroquin. One of the best known fluoroquinolones is ciprofloxacin which is the treatment of choice for anthrax infection, and so was seen widespread in the media during the anthrax terror event of 2001. Synthetic antimicrobials, in contrast to natural antimicrobials, are completely produced in the organic chemistry laboratory and do not begin their “life” as the byproduct of microbial metabolism. Several members of this family do have a significantly higher risk associated with them in causing patient colonization with MRSA isolates or Clostridium difficile, in comparison with other antibiotic treatment regimens. As such, the risks of developing nosocomial infections or promoting the development of antibiotic resistance in other microorganisms has been well appreciated for the fluoroquinolones. Their main utility however continues to be due to the fact that they are broad spectrum antibiotics, and can be used when the etiologic agent of disease has not been determined.
A pharmacologist friend of mine once remarked that “Every drug we use has two effects: the one we know about, and the one we don’t know about.” The utility of an antibiotic stems from its ability to stop the growth or kill a microorganism colonizing the human body, and the principle of selective toxicity means that the design of antibiotics should maximize their effects on microorganisms, while minimizing their effects on human tissues. Unfortunately, no completely selectively toxic antibiotic exists, and consequently unforeseen and unfortunate side effects can frequently occur. The New York Times article tells the story of Lloyd Balch, who took Levaquin for a mild case of pneumonia:
In addition to being unable to walk uphill, climb stairs or see clearly, his symptoms included dry eyes, mouth and skin; ringing in his ears; delayed urination; uncontrollable shaking; burning pain in his eyes and feet; occasional tingling in his hands and feet; heart palpitations; and muscle spasms in his back and around his eyes.
Several months after taking only a second pill, the conditions persisted. As might be apparent from his case study above, symptoms can strike any organ in the body. One reason that these types of side effects are poorly documented is because the medical community lacks significant long term studies on the safety and side effects of popular antibiotics, likely because many of these drugs are typically prescribed for only a short period of time to treat a certain medical condition. Best practices in any case recommend that this class of antibiotics should not be generally prescribed for patients most likely at risk for an adverse reaction (under 18 years old or over 60; pregnant or nursing women), or for patients who have demonstrated an adverse reaction to another antibiotic. In any case, it is essential for consumers to take the initiative and ask their health care worker to clarify what the drug is being taken for, how long it should be taken, what types of side effects have been reported before, and when those side effects typically manifest themselves.
BONUS: As before, commenting below will result in changing an existing quiz grade to a “5”, and furthermore will allow you to participate in my other class bonus opportunity. Comment below by 1) listing ANY antibiotic, 2) list the type of infection it is used to treat, and 3) listing ONE side effect. Please give a link to where you find it. Offer is open until Friday, September 21st.