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Anwar AI, Lu L, Plaisance CJ, Daniel CP, Flanagan CJ, Wenger DM, McGregor D, Varrassi G, Kaye AM, Ahmadzadeh S, Cornett EM, Shekoohi S, Kaye AD. Fluoroquinolones: Neurological Complications and Side Effects in Clinical Practice. Cureus 2024; 16:e54565. [PMID: 38516474 PMCID: PMC10957204 DOI: 10.7759/cureus.54565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Fluoroquinolones, a popular antibiotic class that inhibits nucleic acid synthesis of bacteria by disrupting the activity of the enzyme's topoisomerase IV and DNA gyrase, are used to treat bacterial infections. However, the widespread use of these drugs has allowed for the development of microbial resistance in recent years. Quinolones also have many clinically relevant side effects, including psychosis, confusion, seizures, headaches, dizziness, and nausea. Common side effects include tendinitis, myopathy, depression, and fatigue. Cardiovascular side effects include increased risk of aortic aneurysm, aortic dissection, and QT interval prolongation. Overall, quinolones can be an effective choice for treating bacterial infections. Still, the side effect profile and decreased efficacy secondary to microbial resistance no longer make the quinolone class an ideal choice for many types of infection. A better understanding of the role of quinolone-mediated or neurological damage, cardiovascular impairment, and musculoskeletal involvement is imperative to determine the risks/benefits for the clinician.
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Affiliation(s)
| | - Lei Lu
- Neurology, Medical University of South Carolina, Charleston, USA
| | - Connor J Plaisance
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Charles P Daniel
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Chelsi J Flanagan
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, USA
| | - Danielle M Wenger
- School of Medicine, University of Arizona College of Medicine, Phoenix, USA
| | - David McGregor
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Adam M Kaye
- Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific, Stockton, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Elyse M Cornett
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Levofloxacin Cocrystal/Salt with Phthalimide and Caffeic Acid as Promising Solid-State Approach to Improve Antimicrobial Efficiency. Antibiotics (Basel) 2022; 11:antibiotics11060797. [PMID: 35740203 PMCID: PMC9220774 DOI: 10.3390/antibiotics11060797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
To overcome the issue of multidrug resistant (MDR) microbes, the exploration of ways to improve the antimicrobial efficiency of existing antibiotics is one of the promising approaches. In search of synthons with higher efficiency, in current investigations, cocrystal and amorphous salt of levofloxacin hemihydrate (LEV) were developed with phthalimide (PTH) and caffeic acid (CFA). New materials were characterized with the help of FT-IR, Raman spectroscopy, powder X-ray diffraction (PXRD), differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Shifting, attenuation, appearance/disappearance and broadening of bands were observed in the FT-IR and Raman spectra of the materials as evidence of the required product. The PXRD diffraction pattern observed for LEV-PTH indicated cocrystal while halo diffractogram of LEV-CFA revealed amorphous nature. DSC/TG analysis confirmed the hydrated nature of the cocrystal/salt. The dissolution rate and antimicrobial activity against selected strains, K.pneumonia, E. coli and S. typhi of parent drug and the new material were compared. The zone of inhibition (ZI) observed for 5 µg LEV-PTH was 30.4 + 0.36 (K. pneumonia), 26.33 + 0.35 (E. coli) and 30.03 + 0.25 mm (S. typhi) while LEV-CFA salt (5 µg) against the same strains inhibited 33.96 ± 0.25, 31.66 ± 0.35 and 27.93 ± 0.40 mm, respectively. These novel formulations enhance the dissolution rate as well as antibacterial efficiency and are expected to be potent against MDR bacterial strains.
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Bisaccia DR, Aicale R, Tarantino D, Peretti GM, Maffulli N. Biological and chemical changes in fluoroquinolone-associated tendinopathies: a systematic review. Br Med Bull 2019; 130:39-49. [PMID: 30811525 DOI: 10.1093/bmb/ldz006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/04/2019] [Accepted: 02/10/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The present systematic review investigates the biological and chemical mechanisms that affect the health and structure of tendons following the use of fluoroquinolones (FQs). SOURCES OF DATA A total of 12 articles were included, organized, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. AREAS OF AGREEMENT Five mechanisms were identified: arrest of proliferation through a decreased activity of cyclin B, CDK-1, CHK-1, and increased PK-1; decrease tenocytes migration through decreased phosphorylation of FAK; decrease type I collagen metabolism through increased MMP-2; chelate effect on ions that influence epigenetics and several enzymes; fluoroquinolones-induced ROS (radical oxygen species) production in mitochondria. AREAS OF CONTROVERSY There is no definite structure-damage relationship. The dose-effect relationship is unclear. GROWING POINTS Knowing and defining the damage exerted by FQs plays a role in clinical practice, replacing FQs with other antibacterial drugs or using antioxidants to attenuate their pathological effects. AREAS TIMELY FOR DEVELOPING RESEARCH Clinical and basic sciences studies for each FQs are necessary.
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Affiliation(s)
- Domenico Rocco Bisaccia
- Department of Pharmacology, School of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Domiziano Tarantino
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, England
- Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
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Bandari S, Dronam VR, Eedara BB. Development and preliminary characterization of levofloxacin pharmaceutical cocrystals for dissolution rate enhancement. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2017. [DOI: 10.1007/s40005-016-0302-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Fox AJS, Schär MO, Wanivenhaus F, Chen T, Attia E, Binder NB, Otero M, Gilbert SL, Nguyen JT, Chaudhury S, Warren RF, Rodeo SA. Fluoroquinolones impair tendon healing in a rat rotator cuff repair model: a preliminary study. Am J Sports Med 2014; 42:2851-9. [PMID: 25143490 DOI: 10.1177/0363546514545858] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies suggest that fluoroquinolone antibiotics predispose tendons to tendinopathy and/or rupture. However, no investigations on the reparative capacity of tendons exposed to fluoroquinolones have been conducted. HYPOTHESIS Fluoroquinolone-treated animals will have inferior biochemical, histological, and biomechanical properties at the healing tendon-bone enthesis compared with controls. STUDY DESIGN Controlled laboratory study. METHODS Ninety-two rats underwent rotator cuff repair and were randomly assigned to 1 of 4 groups: (1) preoperative (Preop), whereby animals received fleroxacin for 1 week preoperatively; (2) pre- and postoperative (Pre/Postop), whereby animals received fleroxacin for 1 week preoperatively and for 2 weeks postoperatively; (3) postoperative (Postop), whereby animals received fleroxacin for 2 weeks postoperatively; and (4) control, whereby animals received vehicle for 1 week preoperatively and for 2 weeks postoperatively. Rats were euthanized at 2 weeks postoperatively for biochemical, histological, and biomechanical analysis. All data were expressed as mean ± standard error of the mean (SEM). Statistical comparisons were performed using either 1-way or 2-way ANOVA, with P < .05 considered significant. RESULTS Reverse transcriptase quantitative polymerase chain reaction (RTqPCR) analysis revealed a 30-fold increase in expression of matrix metalloproteinase (MMP)-3, a 7-fold increase in MMP-13, and a 4-fold increase in tissue inhibitor of metalloproteinases (TIMP)-1 in the Pre/Postop group compared with the other groups. The appearance of the healing enthesis in all treated animals was qualitatively different than that in controls. The tendons were friable and atrophic. All 3 treated groups showed significantly less fibrocartilage and poorly organized collagen at the healing enthesis compared with control animals. There was a significant difference in the mode of failure, with treated animals demonstrating an intrasubstance failure of the supraspinatus tendon during testing. In contrast, only 1 of 10 control samples failed within the tendon substance. The healing enthesis of the Pre/Postop group displayed significantly reduced ultimate load to failure compared with the Preop, Postop, and control groups. There was no significant difference in load to failure in the Preop group compared with the Postop group. Pre/Postop animals demonstrated significantly reduced cross-sectional area compared with the Postop and control groups. There was also a significant reduction in area between the Preop and control groups. CONCLUSION In this preliminary study, fluoroquinolone treatment negatively influenced tendon healing. CLINICAL RELEVANCE These findings indicate that there was an active but inadequate repair response that has potential clinical implications for patients who are exposed to fluoroquinolones before tendon repair surgery.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Michael O Schär
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Florian Wanivenhaus
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Tony Chen
- Laboratory for Soft Tissue Research, Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Erik Attia
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Nikolaus B Binder
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Miguel Otero
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Susannah L Gilbert
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T Nguyen
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Salma Chaudhury
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
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Yang SD, Bai ZL, Zhang F, Ma L, Yang DL, Ding WY. Levofloxacin increases the effect of serum deprivation on anoikis of rat nucleus pulposus cells via Bax/Bcl-2/caspase-3 pathway. Toxicol Mech Methods 2014; 24:688-96. [PMID: 25224805 DOI: 10.3109/15376516.2014.963772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Levofloxacin, a fluoroquinolone, is a widely-used and effective antibiotic. However, various adverse side effects are associated with levofloxacin. The purpose of this study was to further explore the effects of levofloxacin on rat nucleus pulposus cells (NPCs). Inverted phase-contrast microscopy, flow cytometry and caspase-3 activity assays were used and revealed that serum deprivation induced apoptosis, which was markedly increased by levofloxacin in a dose-dependent manner. Simultaneously, levofloxacin decreased cell binding to type II collagen (COL2). Thus, levofloxacin-induced apoptosis exhibits characteristics of anoikis, the process by which cell death is triggered by separation from the extracellular matrix, which contains COL2. Furthermore, real-time quantitative RT-PCR was used to further confirm that levofloxacin downregulates COL2 expression in a dose-dependent manner. At last, western blot was used to find that levofloxacin increased the ratio of Bax/Bcl-2 and active caspase-3 in a dose-dependent manner. Levofloxacin therefore increases the effects of serum deprivation on anoikis by downregulating COL2 in rat NPCs in vitro via Bax/Bcl-2/caspase-3 pathway. This research provides a novel insight into the mechanisms of levofloxacin-induced toxicity and may potentially lead to a better understanding of the clinical effects of levofloxacin, especially in terms of intervertebral disc degeneration.
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Yang SD, Ma L, Gu TX, Ding WY, Zhang F, Shen Y, Zhang YZ, Yang DL, Zhang D, Sun YP, Song YL. 17β-Estradiol protects against apoptosis induced by levofloxacin in rat nucleus pulposus cells by upregulating integrin α2β1. Apoptosis 2014; 19:789-800. [DOI: 10.1007/s10495-014-0965-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yu CH, Liu ZY, Sun LS, Li YJ, Zhang DS, Pan RT, Sun ZL. Effect of Danofloxacin on Reactive Oxygen Species Production, Lipid Peroxidation and Antioxidant Enzyme Activities in Kidney Tubular Epithelial Cell Line, LLC-PK1. Basic Clin Pharmacol Toxicol 2013; 113:377-84. [PMID: 23855763 DOI: 10.1111/bcpt.12110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/09/2013] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to investigate the possibility that oxidative stress was involved in danofloxacin-induced toxicity in renal tubular cells epithelial cell line (LLC-PK1). Confluent LLC-PK1 cells were incubated with various concentrations of danofloxacin. The extent of oxidative damage was assessed by measuring the reactive oxygen species (ROS) level, lipid peroxidation, cell apoptosis and antioxidative enzyme activities. Danofloxacin induced a concentration-dependent increase in the ROS production, not even cytotoxic conditions. Similarly, danofloxacin caused an about 4 times increase in the level of thiobarbituric acid reactive substances at the concentration of 400 μM for 24 hr, but it did not induce cytotoxicity and apoptosis. Antioxidant enzymes activities, such as superoxide dismutase (SOD) and catalase (CAT), were increased after treatment with 100, 200 and 400 μM of danofloxacin for 24 hr. The activity of glutathione peroxidase (GPX) was significantly decreased in a concentration-dependent manner. In addition, ROS production, lipid peroxidation and GPX decline were inhibited by additional glutathione and N-acetyl cysteine. These data suggested that danofloxacin could not induce oxidative stress in LLC-PK1 cells at the concentration (≤400 μM) for 24 hr. The increase levels of ROS and lipid peroxidation could be partly abated by the increase activities of SOD and CAT.
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Affiliation(s)
- Chun-Hong Yu
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
| | - Zhao-Ying Liu
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
| | - Lei-Sheng Sun
- College of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yu-Juan Li
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
| | - Da-Sheng Zhang
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
| | - Ren-Tao Pan
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
| | - Zhi-Liang Sun
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, China
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Wang L, Wu Y, Tan Y, Fei X, Deng Y, Cao H, Chen B, Wang H, Magdalou J, Chen L. Cytotoxic effects of the quinolone levofloxacin on rabbit meniscus cells. J Appl Toxicol 2013; 34:870-7. [PMID: 23813946 DOI: 10.1002/jat.2903] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/11/2013] [Accepted: 05/11/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Linlong Wang
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Yunpeng Wu
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Yang Tan
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Xi Fei
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Yu Deng
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Hong Cao
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Biao Chen
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
| | - Hui Wang
- Department of Pharmacology; Basic Medical School of Wuhan University; Wuhan 430071 China
| | - Jacques Magdalou
- UMR 7365 CNRS-Nancy Université; Faculté de Médicine; Vandoeuvre-lès-Nancy France
| | - Liaobin Chen
- Department of Orthopedic Surgery; Zhongnan Hospital of Wuhan University; Wuhan 430071 China
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Tan Y, Lu K, Deng Y, Cao H, Chen B, Wang H, Magdalou J, Chen L. The effects of levofloxacin on rabbit fibroblast-like synoviocytes in vitro. Toxicol Appl Pharmacol 2012; 265:175-80. [DOI: 10.1016/j.taap.2012.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 10/01/2012] [Accepted: 10/05/2012] [Indexed: 11/16/2022]
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