Drugs side effects

Question

Dear expert team,
I (19y) have a question concerning long-term therapy with antibiotics of the group of fluorchinolones (levofloxacin, ciprofloxacin). Is there any experience with CF patients concerning pain of joints, muscle pain repectively ruptures of the Achilles tendon, that do not heal?
In the internet one finds reports about “floxed people” worldwide, who seem to have had really severe damage and that was irreversible.
In Germany and Austria those side effects are rather “downplayed” respectively are described to be very seldom. I have had all the time after 3-4 weeks muscle pain respectively pain of the joints (knee, ankle joint), could then however pause again the drug and then the pain went away again.
However I have again and again pain in the knee or in other joints, that is however attributed to CF arthropathy.
With all the reports, that one reads concerning this topic and as I should now receive a long-term therapy with levofloxacin, that I had to stop due to strong side effects after 12 weeks however, - I ask myself of course, if the pain will go away this time again or if one is really “poisoned”?
Therefore I would like to know, if there is special experience in CF and due to fear about the future – what is the alternative?
Many thanks in advance,
D.I.

Answer

Hello,
the by you described complaints should be taken for serious and can have different causes. As possible side effects after the intake of fluorchinolones like ciprofloxacin, muscle pain occurs sometimes, that means in more than 1/1000 to less than 1/100 patients- Severe side effects concerning the locomotor system, up to rupture of a tendon (mostly Achilles tendon) are very rare, that means they occur in less than 1/1000 patients.
Every drug therapy, also the therapy with fluorchinolones, should be prescribed after thoroughly weighing of possible benefit and possible risks as well as side effects. A reason for an oral (tablets) long term therapy with fluorchinolones is not known to me. The therapy with so called pseudomonas-effective fluorchinolones can be necessary intermittently (over 2-3 weeks) in case of an acute infection exacerbation, if there is a chronic (permanent) infection with Pseudomonas underlying.
The long term therapy with inhalative antbiotics in case of chronic infection with Pseudomonas aeruginosa is justified. Recently, levofloxacin came on the market for this indication. Side effects are however even possible with inhalation of levofloxacin. For a long-term inhalative therapy there are however alternative drugs with other substances available.
As in the frame of the expert panel no individual therapeutical recommendations can be made or can replace the treatment/counsil of your physician, I recommend to contact your CF center, in order to clarify, which kind of therapy is suitable for you personally.
I hope to have helped you a bit with my answer and stay with my best regards,
Christian Hügel

07.10.2016