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Tanaka S, Noda T, Urashima K, Ijiri Y, Kohda Y, Kato R. Reactive metabolite of trovafloxacin activates inflammasomes: Implications for trovafloxacin-induced liver injury. J Appl Toxicol 2024; 44:846-852. [PMID: 38291012 DOI: 10.1002/jat.4585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Trovafloxacin is a quinolone antibiotic drug with broad-spectrum activity, which was withdrawn from a global market relatively soon after approval because of serious liver injury. The characteristics of trovafloxacin-induced liver injury are consistent with an idiosyncratic reaction; however, the details of the mechanism have not been elucidated. We examined whether trovafloxacin induces the release of damage-associated molecular patterns (DAMPs) that activate inflammasomes. We also tested ciprofloxacin, levofloxacin, gatifloxacin, and grepafloxacin for their ability to activate inflammasomes. Drug bioactivation was performed with human hepatocarcinoma functional liver cell-4 (FLC-4) cells, and THP-1 cells (human monocyte cell line) were used for the detection of inflammasome activation. The supernatant from the incubation of trovafloxacin with FLC-4 cells for 7 days increased caspase-1 activity and production of IL-1ß by THP-1 cells. In the supernatant of FLC-4 cells that had been incubated with trovafloxacin, heat shock protein (HSP) 40 was significantly increased. Addition of a cytochrome P450 inhibitor to the FLC-4 cells prevented the release of HSP40 from the FLC-4 cells and inflammasome activation in THP-1 cells by the FLC-4 supernatant. These results suggest that reactive metabolites of trovafloxacin can cause the release of DAMPs from hepatocytes that can activate inflammasomes. Inflammasome activation may be an important step in the activation of the immune system by trovafloxacin, which, in some patients, can cause immune-related liver injury.
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Affiliation(s)
- Saori Tanaka
- Department of Pharmacotherapeutics and Toxicology, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takumi Noda
- Department of Pharmacotherapeutics and Toxicology, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kazuya Urashima
- Department of Pharmacotherapeutics and Toxicology, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshio Ijiri
- Department of Pharmacotherapeutics and Toxicology, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuka Kohda
- Department of Pharmacotherapeutics and Toxicology, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryuji Kato
- Department of Pharmacotherapeutics and Toxicology, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Osaka, Japan
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2
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An X, Zhu X, Liu J, Zou L, Li G, Ye B. Ratiometric fluorescence detection of ciprofloxacin using the terbium-based coordination polymers. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 269:120775. [PMID: 34954482 DOI: 10.1016/j.saa.2021.120775] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Herein, a facile self-assembly through adenosine monophosphate (AMP) and luminol with Tb3+ was employed to construct a dual-ligand coordinated AMP-Tb-luminol coordination polymers (CPs), which emitted the typical fluorescence of luminol. Based on the sensitization effect of ciprofloxacin (CIP) on the luminescence of Tb3+, a ratiometric sensor was fabricated using the fluorescence of luminol as an inert reference. The fluorescent intensity ratios of Tb3+ to that of luminol enhanced linearly with the CIP concentration in the range from 5 nM to 2.5 μM with a lower limit of detection of 2 nM. In addition, the proposed ratiometric fluorescent sensor exhibited high selectivity for CIP, which could also be used to detect CIP in human blood serum (HBS) with satisfactory results. To our knowledge, this is the first demonstration of using dual-ligand coordination lanthanide (Ln)-based CPs for ratio-metric CIP assay, and this straightforward strategy may open up a new platform for designing the ratio-metric sensors based on the Ln CPs.
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Affiliation(s)
- Xinan An
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, PR China
| | - Xinyue Zhu
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, PR China
| | - Jiaojiao Liu
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, PR China
| | - Lina Zou
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, PR China
| | - Gaiping Li
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, PR China.
| | - Baoxian Ye
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, PR China.
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3
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Chen Y, Yang X, Cheng Y, Zhang L, Yang Z, Schipper D. Regulatable Detection of Antibiotics Based on a Near-IR-Luminescent Tubelike Zn(II)-Yb(III) Nanocluster. Inorg Chem 2022; 61:1011-1017. [PMID: 34978442 DOI: 10.1021/acs.inorgchem.1c03071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A tubelike Zn(II)-Yb(III) cluster, [Zn6Yb5L5(HL)(NO3)4(DMF)6(EtOH)4(H2O)4] (1; DMF = N,N-dimethylformamide and EtOH = ethanol; molecular size 1.5 × 1.8 × 2.9 nm), was synthesized from a new long-chain Schiff base ligand. 1 exhibits a regulatable near-IR-luminescent response to nitrofuran antibiotics (NFAs) and fluoroquinolones with high sensitivity, which is not influenced by other antibiotics. The quenching constants of NFAs and fluoroquinolones range from 0.55 × 104 to 8.8 × 104 M-1, and the detection limits of 1 to them are from 4.2 × 10-4 to 2.6 × 10-5 M. It also shows a luminescent response to real antibiotic drugs containing NFAs and fluoroquinolones.
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Affiliation(s)
- Ya Chen
- Zhejiang Key Laboratory of Carbon Materials, College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Xiaoping Yang
- Zhejiang Key Laboratory of Carbon Materials, College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Yuebo Cheng
- Zhejiang Key Laboratory of Carbon Materials, College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Lijie Zhang
- Zhejiang Key Laboratory of Carbon Materials, College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Zhi Yang
- Zhejiang Key Laboratory of Carbon Materials, College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Desmond Schipper
- Department of Chemistry and Biochemistry, The University of Texas at Austin, Austin, Texas 78712, United States
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4
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Ramesh M, Sujitha M, Anila PA, Ren Z, Poopal RK. Responses of Cirrhinus mrigala to second-generation fluoroquinolone (ciprofloxacin) toxicity: Assessment of antioxidants, tissue morphology, and inorganic ions. ENVIRONMENTAL TOXICOLOGY 2021; 36:887-902. [PMID: 33382204 DOI: 10.1002/tox.23091] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
Ciprofloxacin drugs are a second-generation fluoroquinolone highly prescribed medication against various bacterial infections in human and aquaculture practices. These drugs are chemically designed to persist in the body long enough to achieve target objectives. Extensive usage has resulted in ciprofloxacin becoming a ubiquitous contaminant in the environment. Unfortunately, the ecotoxicological profiles for ciprofloxacin are scanty. This study was aimed to assess the ecotoxicity of ciprofloxacin at environmentally relevant concentrations (1 μg/L, and 1.5 μg/L) to a cultivable fish Cirrhinus mrigala. Responses of antioxidant enzymes, histological anomalies, and inorganic ion levels were studied. SOD activity in gill, liver, and kidney tissues was elevated in ciprofloxacin-exposed groups when compared with the control group. CAT activity was predominantly decreased in ciprofloxacin treated groups relative to the control group. GST activity in the ciprofloxacin treated groups was increased (except kidney tissues [Treatment I (1 μg/L)], and gill tissues fifteenth day) significantly (p < .05). The LPO level was elevated in the ciprofloxacin treatment groups throughout the study period (except Treatment II (1.5 μg/L) tenth day in kidney tissues). A series of histological anomalies were noticed in the gill, liver, and kidney tissues of the ciprofloxacin treated groups. Ciprofloxacin exposure caused a significant decrease of sodium, potassium, and chloride levels in the plasma of C. mrigala. A parallel among an imbalanced oxidative defense system, tissue structural changes, and alterations of plasma inorganic ions could be considered as a reliable biomarker for antibiotic toxicity study. This study could be a primary platform for further toxicity studies to understand the potential molecular impacts and adverse effects of ciprofloxacin on aquatic organisms.
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Affiliation(s)
- Mathan Ramesh
- Institute of Environment and Ecology, Shandong Normal University, Jinan, China
- Unit of Toxicology, Department of Zoology, School of Life Sciences, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Madhavan Sujitha
- Unit of Toxicology, Department of Zoology, School of Life Sciences, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Pottanthara Ashokan Anila
- Unit of Toxicology, Department of Zoology, School of Life Sciences, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Zongming Ren
- Institute of Environment and Ecology, Shandong Normal University, Jinan, China
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5
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Niu M, Yang X, Ma Y, Hao W, Leng X, Schipper D. Construction of Zn(II)/Cd(II)-Yb(III) Schiff Base Complexes for the NIR Luminescent Sensing of Fluoroquinolone Antibiotics. Inorg Chem 2021; 60:5764-5770. [PMID: 33829775 DOI: 10.1021/acs.inorgchem.1c00037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Two NIR luminescent Zn(II)/Cd(II)-Yb(III) complexes were obtained by the use of a Schiff base ligand with a binaphthyl backbone. Cd(II)-Yb(III) complex 2 has a triangular structure and exhibits interesting luminescent sensing activity to antibiotics, in particular to ciprofloxacin (CPFX) and norfloxacin (NFX) due to the inner filter effect. The limits of the detection of 2 to CPFX and NFX are 0.18 and 0.36 μM, respectively, and the fluorescence sensitivity is not changed with the existence of other antibiotics tested in this study.
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Affiliation(s)
- Mengyu Niu
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Xiaoping Yang
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Yanan Ma
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Wenxin Hao
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Xilong Leng
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
| | - Desmond Schipper
- Department of Chemistry and Biochemistry, The University of Texas at Austin, Austin, Texas 78712, United States
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6
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Ahmad W, Waqar M, Hadi MH, Muhammad AS, Iqbal N. Acute Cholestatic Liver Injury Due to Ciprofloxacin in a Young Healthy Adult. Cureus 2021; 13:e13340. [PMID: 33747648 PMCID: PMC7967918 DOI: 10.7759/cureus.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ciprofloxacin is a commonly prescribed antibiotic due to its broad spectrum and good safety profile. However, recent evidence suggests that it has the propensity to cause idiosyncratic drug-induced liver injury. There are 25 reported cases of ciprofloxacin induced severe liver injury in the literature. Here, we describe another case of acute cholestatic liver injury due to ciprofloxacin. A 32-year-old female presented to the gastroenterology department with a week's history of pruritus, jaundice, and abdominal pain. Her symptoms started three days after completing a ciprofloxacin course for urinary tract infection. Her hepatic enzymes were elevated and showed a cholestatic pattern. An extensive workup, including viral serology, autoimmune profile, and imaging studies, did not reveal any underlying cholestasis cause. Her liver biopsy findings were consistent with drug-induced cholestasis. A diagnosis of ciprofloxacin-induced cholestatic liver injury was made based on the onset of symptoms and liver enzyme derangements following the use of ciprofloxacin, improvement in clinical as well as biochemical parameters after cessation of ciprofloxacin, and the liver biopsy findings. The patient received supportive treatment, and her liver enzymes returned to baseline six weeks after admission. Clinicians need to be aware that if the patient develops any liver injury symptoms while using ciprofloxacin, the drug should be stopped immediately, and a thorough evaluation should be done. The patient should also be advised to avoid ciprofloxacin and other quinolones in the future.
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Affiliation(s)
- Wiqas Ahmad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Gastroenterology and Hepatology, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Muhammad Waqar
- Internal Medicine, The Dudley Group NHS Foundation Trust, Dudley, GBR
| | - Muhammad Hanif Hadi
- Gastroenterology and Hepatology, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Agha Syed Muhammad
- Internal Medicine and Gastroenterology, Russells Hall Hospital, Dudley, GBR
| | - Nasir Iqbal
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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7
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Radovanovic M, Dushenkovska T, Cvorovic I, Radovanovic N, Ramasamy V, Milosavljevic K, Surla J, Jecmenica M, Radulovic M, Milovanovic T, Dumic I. Idiosyncratic Drug-Induced Liver Injury Due to Ciprofloxacin: A Report of Two Cases and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1152-1161. [PMID: 30266895 PMCID: PMC6181557 DOI: 10.12659/ajcr.911393] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Case series Patient: Male, 35 • Male, 82 Final Diagnosis: Idiosyncratic DILI due to Ciprofloxacin Symptoms: Abdominal discomfort • fever • jaundice • nausea Medication: Ciprofloxacin Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Milan Radovanovic
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA
| | - Tetyana Dushenkovska
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA
| | - Ivan Cvorovic
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA
| | - Natasa Radovanovic
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA
| | - Vimala Ramasamy
- Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Jelena Surla
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA
| | - Mladen Jecmenica
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Miroslav Radulovic
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tamara Milovanovic
- Department of Gastroenterology and Hepatology, Belgrade University School of Medicine, Belgrade, Serbia
| | - Igor Dumic
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, North Central Bronx Hospital, Bronx, NY, USA
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8
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9
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Gui R, Bu X, He W, Jin H. Ratiometric fluorescence, solution-phase and filter-paper visualization detection of ciprofloxacin based on dual-emitting carbon dot/silicon dot hybrids. NEW J CHEM 2018. [DOI: 10.1039/c8nj03788d] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study demonstrates the ratiometric fluorescence, solution-phase and filter-paper visual detection of ciprofloxacin based on dual-emitting carbon dot/silicon dot hybrids.
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Affiliation(s)
- Rijun Gui
- College of Chemistry and Chemical Engineering
- Shandong Sino-Japanese Center for Collaborative Research of Carbon Nanomaterials
- Laboratory of Fiber Materials and Modern Textile
- The Growing Base for State Key Laboratory
- Qingdao University
| | - Xiangning Bu
- College of Chemistry and Chemical Engineering
- Shandong Sino-Japanese Center for Collaborative Research of Carbon Nanomaterials
- Laboratory of Fiber Materials and Modern Textile
- The Growing Base for State Key Laboratory
- Qingdao University
| | - Weijie He
- College of Chemistry and Chemical Engineering
- Shandong Sino-Japanese Center for Collaborative Research of Carbon Nanomaterials
- Laboratory of Fiber Materials and Modern Textile
- The Growing Base for State Key Laboratory
- Qingdao University
| | - Hui Jin
- College of Chemistry and Chemical Engineering
- Shandong Sino-Japanese Center for Collaborative Research of Carbon Nanomaterials
- Laboratory of Fiber Materials and Modern Textile
- The Growing Base for State Key Laboratory
- Qingdao University
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10
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Boulila S, Oudadesse H, Kallel R, Lefeuvre B, Mabrouk M, Chaabouni K, Makni-Ayedi F, Boudawara T, Elfeki A, Elfeki H. In vivo study of hybrid biomaterial scaffold bioactive glass–chitosan after incorporation of Ciprofloxacin. Polym Bull (Berl) 2017. [DOI: 10.1007/s00289-017-1936-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Detection of Ciprofloxacin in Urine through Sensitized Lanthanide Luminescence. SENSORS 2016; 16:s16122065. [PMID: 27929396 PMCID: PMC5191046 DOI: 10.3390/s16122065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 02/04/2023]
Abstract
Ciprofloxacin, a fluoroquinolone antibiotic, is widely used for the treatment of bacterial infection in humans due to its broad antibacterial spectrum. An excessive use or overdose of ciprofloxacin on the other hand can cause several adverse effects not only to humans but also to microorganisms. Unabsorbed ciprofloxacin in the body is mostly excreted through urine and finally goes to the environment, providing a drug resistance pressure on bacteria. Hence a simple and efficient detection method of ciprofloxacin is necessary, which, for example, can be used to analyze ciprofloxacin content in urine. Although ciprofloxacin itself shows inherent fluorescence, direct fluorescent detection of ciprofloxacin in raw urine sample is difficult due to autofluorescence of urine by other components. Herein we report that a Tb(III) complex of DO3A (1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid) can be efficiently sensitized by ciprofloxacin to emit luminescence separately from the urine autofluorescence wavelength region. Tb-DO3A shows excellent sensitivity with a detection limit of three parts per billion in aqueous buffer solution. Further, Tb-DO3A is used to detect ciprofloxacin with high sensitivity and selectivity in a raw urine sample without any purification or separation procedures in the concentrations ranging from 1 µg·mL−1 to 50 µg·mL−1. The direct measurement of ciprofloxacin excreted in urine may be used to control overdose of the drug.
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12
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Unger C, Al-Jashaami LS. Ciprofloxacin Exposure Leading to Fatal Hepatotoxicity: An Unusual Correlation. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:676-681. [PMID: 27653941 PMCID: PMC5036381 DOI: 10.12659/ajcr.899080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Female, 74 Final Diagnosis: Acute drug-induced liver failure Symptoms: Anorexia • fatigue • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Carly Unger
- , Bethel University Physician Assistant Program, Paris, TN, USA
| | - Layth S Al-Jashaami
- Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA
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13
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Taslidere E, Dogan Z, Elbe H, Vardi N, Cetin A, Turkoz Y. Quercetin protection against ciprofloxacin induced liver damage in rats. Biotech Histochem 2015; 91:116-21. [DOI: 10.3109/10520295.2015.1085093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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14
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Alshammari TM, Larrat EP, Morrill HJ, Caffrey AR, Quilliam BJ, Laplante KL. Risk of hepatotoxicity associated with fluoroquinolones: A national case–control safety study. Am J Health Syst Pharm 2014; 71:37-43. [DOI: 10.2146/ajhp130165] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - E. Paul Larrat
- College of Pharmacy, University of Rhode Island (URI), Kingston; at the time of this study, he was Professor of Pharmacy, College of Pharmacy, URI
| | - Haley J. Morrill
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center (VAMC), Providence, RI, and College of Pharmacy, URI
| | - Aisling R. Caffrey
- Infectious Diseases Research Program, Providence VAMC, and Assistant Professor of Pharmacoepidemiology, College of Pharmacy, URI
| | | | - Kerry L. Laplante
- College of Pharmacy, URI; Providence VAMC; and Adjunct Clinical Associate Professor of Medicine, Brown University, Providence
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15
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Tan H, Zhang L, Ma C, Song Y, Xu F, Chen S, Wang L. Terbium-based coordination polymer nanoparticles for detection of ciprofloxacin in tablets and biological fluids. ACS APPLIED MATERIALS & INTERFACES 2013; 5:11791-11796. [PMID: 24156699 DOI: 10.1021/am403442q] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The metal-organic coordination polymers with tunable structures and properties have been rapidly emerging as very important functional materials. In this work, we prepared terbium (Tb(3+))-based coordination polymer nanoparticles (CPNPs) by employing adenine (Ad) as bridging ligands. The CPNPs was further used as a receptor reagent for ciprofloxacin (CF) detection in aqueous solution. Addition of CF induces a typical emission of Tb(3+) due to the formation of Ad/Tb-CF complex and the sensitization of CF. The fluorescent intensity of Tb(3+) was enhanced linearly with increasing the CF concentration from 60 nM to 14 μM. The detection limit for CF in aqueous solution is 60 nM. The Ad/Tb CPNPs was successfully applied to detect CF in tablet and urine samples and showed a satisfactory result. Compared with other methods, the proposed method is advantageous because that it provides a very simple strategy for CF detection, which does not require complicated sample pretreatment processes or special reaction media. The proposed strategy could be contributed to expand the potential applications of lanthanide coordination polymers in biological and environmental fields.
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Affiliation(s)
- Hongliang Tan
- Key Laboratory of Functional Small Organic Molecule, Ministry of Education, Key Laboratory of Chemical Biology, Jiangxi Province, College of Chemistry and Chemical Engineering, Jiangxi Normal University , Nanchang 330022, P. R. China
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16
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Paterson JM, Mamdani MM, Manno M, Juurlink DN. Fluoroquinolone therapy and idiosyncratic acute liver injury: a population-based study. CMAJ 2012; 184:1565-70. [PMID: 22891208 DOI: 10.1503/cmaj.111823] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although fluoroquinolones are sometimes associated with mild, transient elevations in aminotransferase levels, serious acute liver injury is uncommon. Regulatory warnings have identified moxifloxacin as presenting a particular risk of hepatotoxicity. Thus, we examined the risk of idiosyncratic acute liver injury associated with the use of moxifloxacin relative to other selected antibiotic agents. METHODS We conducted a population-based, nested, case-control study using health care data from Ontario for the period April 2002 to March 2011. We identified cases as outpatients aged 66 years or older with no history of liver disease, and who were admitted to hospital for acute liver injury within 30 days of receiving a prescription for 1 of 5 broad-spectrum antibiotic agents: moxifloxacin, levofloxacin, ciprofloxacin, cefuroxime axetil or clarithromycin. For each case, we selected up to 10 age- and sex-matched controls from among patients who had received a study antibiotic, but who were not admitted to hospital for acute liver injury. We calculated odds ratios (ORs) to determine the association between admission to hospital and previous exposure to an antibiotic agent, using clarithromycin as the reference. RESULTS A total of 144 patients were admitted to hospital for acute liver injury within 30 days of receiving a prescription for one of the identified drugs. Of these patients, 88 (61.1%) died while in hospital. After multivariable adjustment, use of either moxifloxacin (adjusted OR 2.20, 95% confidence interval [CI] 1.21-3.98) or levofloxacin (adjusted OR 1.85, 95% CI 1.01-3.39) was associated with an increase in risk of acute liver injury relative to the use of clarithromycin. We saw no such risk associated with the use of either ciprofloxacin or cefuroxime axetil. INTERPRETATION Among older outpatients with no evidence of liver disease, moxifloxacin and levofloxacin were associated with an increased risk of acute liver injury relative to clarithromycin.
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17
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Licata A, Randazzo C, Morreale I, Butera G, D’Alessandro N, Craxì A. Fluoroquinolone-induced liver injury: three new cases and a review of the literature. Eur J Clin Pharmacol 2012; 68:525-32. [DOI: 10.1007/s00228-011-1201-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/13/2011] [Indexed: 12/27/2022]
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18
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Adikwu E, Brambaifa N. Ciprofloxacin Cardiotoxicity and Hepatotoxicity in Humans and Animals. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/pp.2012.32028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Park MY, Yoon D, Lee K, Kang SY, Park I, Lee SH, Kim W, Kam HJ, Lee YH, Kim JH, Park RW. A novel algorithm for detection of adverse drug reaction signals using a hospital electronic medical record database. Pharmacoepidemiol Drug Saf 2011; 20:598-607. [PMID: 21472818 DOI: 10.1002/pds.2139] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Quantitative analytic methods are being increasingly used in postmarketing surveillance. However, currently existing methods are limited to spontaneous reporting data and are inapplicable to hospital electronic medical record (EMR) data. The principal objectives of this study were to propose a novel algorithm for detecting the signals of adverse drug reactions using EMR data focused on laboratory abnormalities after treatment with medication, and to evaluate the potential use of this method as a signal detection tool. METHODS We developed an algorithm referred to as the Comparison on Extreme Laboratory Test results, which takes an extreme representative value pair according to the types of laboratory abnormalities on the basis of each patient's medication point. We used 10 years' EMR data from a tertiary teaching hospital, containing 32,033,710 prescriptions and 115,241,147 laboratory tests for 530,829 individual patients. Ten drugs were selected randomly for analysis, and 51 laboratory values were matched. The sensitivity, specificity, positive predictive value, and negative predictive value of the algorithm were calculated. RESULTS The mean number of detected laboratory abnormality signals for each drug was 27 (±7.5). The sensitivity, specificity, positive predictive value, and negative predictive value of the algorithm were 64-100%, 22-76%, 22-75%, and 54-100%, respectively. CONCLUSION The results of this study demonstrated that the Comparison on Extreme Laboratory Test results algorithm described herein was extremely effective in detecting the signals characteristic of adverse drug reactions. This algorithm can be regarded as a useful signal detection tool, which can be routinely applied to EMR data.
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Affiliation(s)
- Man Young Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
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21
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Clinical and histopathologic features of fluoroquinolone-induced liver injury. Clin Gastroenterol Hepatol 2011; 9:517-523.e3. [PMID: 21356330 PMCID: PMC3718017 DOI: 10.1016/j.cgh.2011.02.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 01/23/2011] [Accepted: 02/13/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fluoroquinolone-induced liver injury is rare; no prospective studies of well-characterized case series have been published. We studied patients with fluoroquinolone-induced hepatotoxicity from the Drug-Induced Liver Injury Network (DILIN) to characterize injury patterns, outcomes, and associated features. METHODS We identified subjects with fluoroquinolone hepatotoxicity enrolled in the DILIN from September 2004 to January 2010. Demographic, clinical, and laboratory data were analyzed by descriptive statistical methods. RESULTS Of the 679 registrants in the DILIN prospective study, 12 had fluoroquinolone hepatotoxicity (6 ciprofloxacin, 4 moxifloxacin, 1 levofloxacin, and 1 gatifloxacin). Seven were women; median age was 57 years (range, 23-80 years), and median time from fluoroquinolone start to symptoms was only 4 days (range, 1-39 days). Nine patients developed symptoms on medication; 3 did so 2, 8, and 32 days after stopping the medication. Cases were equally distributed among hepatocellular injury (predominantly increased levels of alanine aminotransferase), cholestatic injury (predominantly increased levels of alkaline phosphatase), and both. Seven patients had immunoallergic features. Patients with mixed hepatocellular and cholestatic injury had mild disease without jaundice; all recovered. In contrast, 2 of 4 patients with hepatocellular injury and jaundice died, 1 of acute liver failure. One patient with cholestatic injury developed vanishing bile duct syndrome and required liver transplantation; another had a persistently increased serum level of alkaline phosphatase. CONCLUSIONS Fluoroquinolone liver injury is rapid in onset and often has immunoallergic features, indicating a hypersensitivity reaction. The pattern of injury can be hepatocellular, cholestatic, or mixed; mixed cases are the least severe. Acute and chronic liver failure can occur.
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Abstract
Antibiotics used by general practitioners frequently appear in adverse-event reports of drug-induced hepatotoxicity. Most cases are idiosyncratic (the adverse reaction cannot be predicted from the drug's pharmacological profile or from pre-clinical toxicology tests) and occur via an immunological reaction or in response to the presence of hepatotoxic metabolites. With the exception of trovafloxacin and telithromycin (now severely restricted), hepatotoxicity crude incidence remains globally low but variable. Thus, amoxicillin/clavulanate and co-trimoxazole, as well as flucloxacillin, cause hepatotoxic reactions at rates that make them visible in general practice (cases are often isolated, may have a delayed onset, sometimes appear only after cessation of therapy and can produce an array of hepatic lesions that mirror hepatobiliary disease, making causality often difficult to establish). Conversely, hepatotoxic reactions related to macrolides, tetracyclines and fluoroquinolones (in that order, from high to low) are much rarer, and are identifiable only through large-scale studies or worldwide pharmacovigilance reporting. For antibiotics specifically used for tuberculosis, adverse effects range from asymptomatic increases in liver enzymes to acute hepatitis and fulminant hepatic failure. Yet, it is difficult to single out individual drugs, as treatment always entails associations. Patients at risk are mainly those with previous experience of hepatotoxic reaction to antibiotics, the aged or those with impaired hepatic function in the absence of close monitoring, making it important to carefully balance potential risks with expected benefits in primary care. Pharmacogenetic testing using the new genome-wide association studies approach holds promise for better understanding the mechanism(s) underlying hepatotoxicity.
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Affiliation(s)
- Raúl J Andrade
- Hepatology Unit, Gastroenterology Service, Virgen de la Victoria University Hospital Department of Medicine, University of Málaga, Spain
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Alan C, Koçoğlu H, Ersay AR, Ertung Y, Kurt HA. Unexpected severe hepatotoxicity of ciprofloxacine: two case reports. Drug Chem Toxicol 2011; 34:189-91. [DOI: 10.3109/01480545.2010.495392] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ahmad S, Hunter L, Qin A, Mann BJ, van Hoek ML. Azithromycin effectiveness against intracellular infections of Francisella. BMC Microbiol 2010; 10:123. [PMID: 20416090 PMCID: PMC2881020 DOI: 10.1186/1471-2180-10-123] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 04/23/2010] [Indexed: 12/27/2022] Open
Abstract
Background Macrolide antibiotics are commonly administered for bacterial respiratory illnesses. Azithromycin (Az) is especially noted for extremely high intracellular concentrations achieved within macrophages which is far greater than the serum concentration. Clinical strains of Type B Francisella (F.) tularensis have been reported to be resistant to Az, however our laboratory Francisella strains were found to be sensitive. We hypothesized that different strains/species of Francisella (including Type A) may have different susceptibilities to Az, a widely used and well-tolerated antibiotic. Results In vitro susceptibility testing of Az confirmed that F. tularensis subsp. holarctica Live Vaccine Strain (LVS) (Type B) was not sensitive while F. philomiragia, F. novicida, and Type A F. tularensis (NIH B38 and Schu S4 strain) were susceptible. In J774A.1 mouse macrophage cells infected with F. philomiragia, F. novicida, and F. tularensis LVS, 5 μg/ml Az applied extracellularly eliminated intracellular Francisella infections. A concentration of 25 μg/ml Az was required for Francisella-infected A549 human lung epithelial cells, suggesting that macrophages are more effective at concentrating Az than epithelial cells. Mutants of RND efflux components (tolC and ftlC) in F. novicida demonstrated less sensitivity to Az by MIC than the parental strain, but the tolC disc-inhibition assay demonstrated increased sensitivity, indicating a complex role for the outer-membrane transporter. Mutants of acrA and acrB mutants were less sensitive to Az than the parental strain, suggesting that AcrAB is not critical for the efflux of Az in F. novicida. In contrast, F. tularensis Schu S4 mutants ΔacrB and ΔacrA were more sensitive than the parental strain, indicating that the AcrAB may be important for Az efflux in F. tularensis Schu S4. F. novicida LPS O-antigen mutants (wbtN, wbtE, wbtQ and wbtA) were found to be less sensitive in vitro to Az compared to the wild-type. Az treatment prolonged the survival of Galleria (G.) mellonella infected with Francisella. Conclusion These studies demonstrate that Type A Francisella strains, as well as F. novicida and F. philomiragia, are sensitive to Az in vitro. Francisella LPS and the RND efflux pump may play a role in Az sensitivity. Az also has antimicrobial activity against intracellular Francisella, suggesting that the intracellular concentration of Az is high enough to be effective against multiple strains/species of Francisella, especially in macrophages. Az treatment prolonged survival an in vivo model of Francisella-infection.
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Affiliation(s)
- Saira Ahmad
- Department of Molecular and Microbiology, National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA 20120, USA
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Chung DT, Tsai CY, Chen SJ, Chang LW, King CHR, Hsu CH, Chiu KM, Tan HC, Chang YT, Hsu MC. Multiple-dose safety, tolerability, and pharmacokinetics of oral nemonoxacin (TG-873870) in healthy volunteers. Antimicrob Agents Chemother 2010; 54:411-7. [PMID: 19884374 PMCID: PMC2798523 DOI: 10.1128/aac.00683-09] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 07/17/2009] [Accepted: 10/23/2009] [Indexed: 01/17/2023] Open
Abstract
Nemonoxacin (TG-873870) is a novel nonfluorinated quinolone with broad-spectrum activities against Gram-positive and Gram-negative aerobic, anaerobic, and atypical pathogens, as well as against methicillin-resistant Staphylococcus aureus, vancomycin-resistant S. aureus, and multiple-resistant bacterial pathogens. We conducted a randomized, double-blind, placebo-controlled, dose-escalating study to ascertain the safety, tolerability, and pharmacokinetics of nemonoxacin. We enrolled 46 healthy volunteers and used a once-daily oral-dosing range of 75 to 1,000 mg for 10 days. Additionally, the food effect was evaluated in subjects in the 500-mg cohort. Nemonoxacin was generally safe and well tolerated, with no significant changes in the clinical laboratory tests or electrocardiograms. Adverse effects, including headache, contact dermatitis, and rash, were mild and resolved spontaneously. Nemonoxacin was rapidly absorbed within 2 h postdosing, and generally, a steady state was reached after 3 days. The maximum plasma concentration and the area under the plasma concentration-time curve were dose proportional over the dosing range. The elimination half-life was approximately 7.5 h and 19.7 h on days 1 and 10, respectively. Approximately 37 to 58% of the drug was excreted in the urine. Food affected the pharmacokinetics, with decreases in the maximum plasma concentration and area under the plasma concentration-time curve of 46% and 27%, respectively. However, the free AUC/MIC(90) of nemonoxacin was more than 100 under both the fasting and fed conditions, predicting the efficacy of nemonoxacin against most of the tested pathogens. In conclusion, the results support further clinical investigation of once-daily nemonoxacin administration for antibiotic-sensitive and antibiotic-resistant bacterial infections.
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Affiliation(s)
- David T Chung
- TaiGen Biotechnology Co. Ltd., 7F, 138 Xing Ming Road, Neihu District, 11470 Taipei, Taiwan.
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Hirsch AC, Lundquist LM. Ciprofloxacin-Induced Hepatotoxicity Resolved with Levofloxacin: A Case Report and a Review of the Literature. Hosp Pharm 2009. [DOI: 10.1310/hpj4411-978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective To report a case of elevated hepatic transaminases in a patient receiving ciprofloxacin that resolved upon discontinuation and initiation of levofloxacin. Summary A 45-year-old white woman was initiated on ciprofloxacin and gentamicin after a blood culture revealed gram-negative rods. On day 2 of antibiotic therapy, the patient's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) increased to 2,352 units/L and 783 units/L, respectively, and remained elevated for the following 4 days. Baseline AST and ALT were within normal limits. On day 5 of therapy, ciprofloxacin was discontinued and levofloxacin was initiated. On the following day, the hepatic transaminases decreased (AST, 192 units/L; ALT, 582 units/L) and continued to normalize prior to hospital discharge. On a subsequent admission later in the month, levofloxacin was again administered for treatment of a gram-positive bacteremia, with no subsequent elevation of hepatic transaminases. Discussion An objective causality assessment revealed that the adverse drug reaction (ADR) was probable. Although reports of this ADR have been noted, there is no previously documented occurrence of resolution of elevated hepatic transaminases on therapeutic modification to another fluoroquinolone. Conclusion Ciprofloxacin may significantly elevate hepatic transaminases. The clinician should be aware of the unique ADR profiles of the different fluoroquinolones because hepatotoxicity may not be a class effect.
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Affiliation(s)
- Adina C. Hirsch
- Saint Joseph's Hospital, Department of Pharmacy, Atlanta, Georgia
| | - Lisa M. Lundquist
- Mercer University College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Atlanta, Georgia
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Rampal S, Kaur R, Sethi R, Singh O, Sood N. Ofloxacin-associated retinopathy in rabbits: role of oxidative stress. Hum Exp Toxicol 2008; 27:409-15. [DOI: 10.1177/0960327108092295] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ofloxacin, a quinolone, is an extensively used, well-tolerated antibacterial agent but has been reported to induce photosensitivity at low incidences. In the present investigation, the possible role of oxidative stress in ofloxacin-induced retinopathy in rabbits was evaluated. It was observed that ofloxacin at a dose rate of 10 and 20 mg/rabbit, twice daily for 21 consecutive days, resulted in significant elevation in the extent of lipid peroxidation and depletion of the blood glutathione levels. Marked alterations were also observed in various parameters of the glutathione-redox cycle. There was significant increase in the enzymic activity of glutathione peroxidase and glutathione reductase, whereas a significant decrease was observed in the activities of superoxide dismutase, catalase, and glutathione-S-transferase enzymes. Histopathological studies revealed retinal damage especially in the pigmented cell layer. Degenerative changes in liver and kidneys were also observed. Liver showed focal areas of necrosis, dilation of sinusoids, and cellular infiltration, whereas in kidneys, there was glomerular and tubular degeneration, suggesting impaired renal functioning.
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Affiliation(s)
- S Rampal
- Department of Pharmacology and Toxicology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, India
| | - R Kaur
- Department of Pharmacology and Toxicology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, India
| | - R Sethi
- Department of Anatomy and Histology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, India
| | - O Singh
- Department of Anatomy and Histology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, India
| | - N Sood
- Department of Pathology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, India
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Lemus JÁ, Blanco G, Grande J, Arroyo B, García-Montijano M, Martínez F. Antibiotics threaten wildlife: circulating quinolone residues and disease in Avian scavengers. PLoS One 2008; 3:e1444. [PMID: 18197254 PMCID: PMC2186382 DOI: 10.1371/journal.pone.0001444] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/18/2007] [Indexed: 11/18/2022] Open
Abstract
Antibiotic residues that may be present in carcasses of medicated livestock could pass to and greatly reduce scavenger wildlife populations. We surveyed residues of the quinolones enrofloxacin and its metabolite ciprofloxacin and other antibiotics (amoxicillin and oxytetracycline) in nestling griffon Gyps fulvus, cinereous Aegypius monachus and Egyptian Neophron percnopterus vultures in central Spain. We found high concentrations of antibiotics in the plasma of many nestling cinereous (57%) and Egyptian (40%) vultures. Enrofloxacin and ciprofloxacin were also found in liver samples of all dead cinereous vultures. This is the first report of antibiotic residues in wildlife. We also provide evidence of a direct association between antibiotic residues, primarily quinolones, and severe disease due to bacterial and fungal pathogens. Our results indicate that, by damaging the liver and kidney and through the acquisition and proliferation of pathogens associated with the depletion of lymphoid organs, continuous exposure to antibiotics could increase mortality rates, at least in cinereous vultures. If antibiotics ingested with livestock carrion are clearly implicated in the decline of the vultures in central Spain then it should be considered a primary concern for conservation of their populations.
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Affiliation(s)
- Jesús Á. Lemus
- Departamento de Ecología Evolutiva, Museo de Ciencias Naturales, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Guillermo Blanco
- Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM), Junta de Comunidades de Castilla-La Mancha (JCCM), Ciudad Real, Spain
- * To whom correspondence should be addressed. E-mail:
| | - Javier Grande
- Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM), Junta de Comunidades de Castilla-La Mancha (JCCM), Ciudad Real, Spain
| | - Bernardo Arroyo
- Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM), Junta de Comunidades de Castilla-La Mancha (JCCM), Ciudad Real, Spain
| | | | - Felíx Martínez
- Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM), Junta de Comunidades de Castilla-La Mancha (JCCM), Ciudad Real, Spain
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Abstract
Fluoroquinolone antibiotics cause immediate and delayed hypersensitivity reactions, and may also affect internal organs and circulating blood cells. The underlying pathomechanisms are only partly understood. The extent of cross-reactivity among different quinolones depends on the type of clinical manifestation and its underlying mechanism. Despite recent advances, reliable diagnostic tests are still lacking. Recent studies have shown quinolone-specific IgE in vitro in more than 50% of patients with immediate-type reactions and a considerable cross-reactivity with related compounds. In maculopapular drug exanthems from ciprofloxacin, specific T-cell clones were identified, and cross-reactivity to related compounds was detected in approximately 50% of the clones. From re-exposure studies in patients with exanthems, cross-reactivity appears to be lower. Cellular tests such as lymphocyte transformation tests are currently not very useful. For prick and intradermal skin tests, widely divergent nonirritant test concentrations have been recommended. Desensitization may be possible in selected patients.
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Affiliation(s)
- Kathrin Scherer
- Allergy Unit, Department of Dermatology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland
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