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Badamasi IM, Muhammad M, Umar AA, Madugu UAM, Gadanya MA, Aliyu IA, Kabir IM, Umar IA, Johnson O, Stanslas J. Role of the IL8 rs4073 polymorphism in central nervous system toxicity in patients receiving multidrug-resistant tuberculosis treatment. J Bras Pneumol 2024; 50:e20230338. [PMID: 38359298 PMCID: PMC11095930 DOI: 10.36416/1806-3756/e20230338] [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: 09/05/2023] [Accepted: 11/01/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To determine the role of the IL8 rs4073 polymorphism in predicting the risk of central nervous system (CNS) toxicity in patients receiving standard pharmacological treatment for multidrug-resistant tuberculosis (MDR-TB). METHODS A cohort of 85 consenting MDR-TB patients receiving treatment with second-line antituberculosis drugs had their blood samples amplified for the IL8 (rs4073) gene and genotyped. All patients were clinically screened for evidence of treatment toxicity and categorized accordingly. Crude and adjusted associations were assessed. RESULTS The chief complaints fell into the following categories: CNS toxicity; gastrointestinal toxicity; skin toxicity; and eye and ear toxicities. Symptoms of gastrointestinal toxicity were reported by 59% of the patients, and symptoms of CNS toxicity were reported by 42.7%. With regard to the genotypes of IL8 (rs4073), the following were identified: AA, in 64 of the study participants; AT, in 7; and TT, in 11. A significant association was found between the dominant model of inheritance and CNS toxicity for the crude model (p = 0.024; OR = 3.57; 95% CI, 1.18-10.76) and the adjusted model (p = 0.031; OR = 3.92; 95% CI, 1.13-13.58). The AT+TT genotype of IL8 (rs4073) showed a 3.92 times increased risk of CNS toxicity when compared with the AA genotype. CONCLUSIONS The AT+TT genotype has a tendency to be associated with an increased risk of adverse clinical features during MDR-TB treatment.
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Affiliation(s)
- Ibrahim Mohammed Badamasi
- . Pharmacogenomic Unit, Department of Human Anatomy, Faculty of Basic Medical Sciences - FBMS - College of Medicine, Bayero University, Kano, Kano, Nigeria
| | - Muktar Muhammad
- . Pharmacogenomic Unit, Department of Human Anatomy, Faculty of Basic Medical Sciences - FBMS - College of Medicine, Bayero University, Kano, Kano, Nigeria
| | - Aishat Ahmad Umar
- . Pharmacogenomic Unit, Department of Human Anatomy, Faculty of Basic Medical Sciences - FBMS - College of Medicine, Bayero University, Kano, Kano, Nigeria
| | - Umm-ayman Misbahu Madugu
- . Pharmacogenomic Unit, Department of Human Anatomy, Faculty of Basic Medical Sciences - FBMS - College of Medicine, Bayero University, Kano, Kano, Nigeria
| | - Muktar Ahmed Gadanya
- . Department of Community Medicine, Faculty of Clinical Sciences, Bayero University, Kano, Kano, Nigeria
| | - Isa Abubakar Aliyu
- . Department of Medical Laboratory Science, Faculty of Allied Health Sciences - FAHS - Bayero University, Kano, Kano, Nigeria
| | - Imam Malik Kabir
- . Department of Medical Laboratory Science, Faculty of Allied Health Sciences - FAHS - Bayero University, Kano, Kano, Nigeria
| | - Ibrahim Aliyu Umar
- . Kano State TB and Leprosy Control Program, Kano State Ministry of Health, Kano, Nigeria
| | - Ochigbo Johnson
- . Kano State Infectious Disease Hospital, Kano State Ministry of Health, Kano, Nigeria
| | - Johnson Stanslas
- . Pharmacotherapeutics Lab, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Javed H, Ali HT, Soliman ZA, Caprara ALF, Rissardo JP. Three Cases of Myoclonus Secondary to Ciprofloxacin: "Ciproclonus". Clin Neuropharmacol 2023; 46:200-203. [PMID: 37748004 DOI: 10.1097/wnf.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Ciprofloxacin is a fluoroquinolone that is used for bacterial infections involving different systems. In some cases, ciprofloxacin was reported to induce myoclonus. METHODS We performed a chart review of 3 patients with myoclonus secondary to ciprofloxacin and reviewed the literature for similar cases. Written consent for publication was obtained from each patient, and their identities were concealed for ethical reasons. RESULTS We describe 3 cases of myoclonus secondary to ciprofloxacin, 2 males and a female aged 61, 26, and 48 years, respectively. The myoclonus appeared within 3 days of ciprofloxacin intake. In all 3 cases, ciprofloxacin was prescribed for urinary tract infection. Electroencephalogram and neuroimaging studies were normal and possible causes were excluded. Thus, ciprofloxacin was believed to be the underlying cause and hence it was withdrawn. The patients had complete recovery on follow-up. CONCLUSIONS Although ciprofloxacin is widely prescribed for different infections, only 13 cases were reported to develop myoclonus secondary to ciprofloxacin. The mean age of patients was 62 years. Fifty-four percent of cases were males. Cessation of ciprofloxacin was the most common management course. All individuals fully recovered after ciprofloxacin withdrawal. The mechanism of ciprofloxacin-induced myoclonus is probably associated with γ-aminobutyric acid and glutamate pathways.
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Affiliation(s)
- Hamna Javed
- Lahore Medical and Dental College, Lahore, Pakistan
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Rissardo JP, Caprara ALF. Fluoroquinolone-Associated Movement Disorder: A Literature Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:33. [PMID: 37367728 DOI: 10.3390/medicines10060033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Fluoroquinolones (FQNs) are related to several central nervous system side effects. This review aims to evaluate the clinical-epidemiological profile, pathophysiological mechanisms, and management of FQNs-associated movement disorders (MDs). METHODS Two reviewers identified and assessed relevant reports in six databases without language restriction between 1988 and 2022. RESULTS A total of 45 reports containing 51 cases who developed MDs secondary to FQNs were reported. The MDs included 25 myoclonus, 13 dyskinesias, 7 dystonias, 2 cerebellar syndromes, 1 ataxia, 1 tic, and 2 undefined cases. The FQNs reported were ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, levofloxacin, gemifloxacin, and pefloxacin. The mean and median age were 64.54 (SD: 15.45) and 67 years (range: 25-87 years). The predominant sex was male (54.16%). The mean and median time of MD onset were 6.02 (SD: 10.87) and 3 days (range: 1-68 days). The mean and median recovery time after MD treatment was 5.71 (SD: 9.01) and 3 days (range: 1-56 days). A complete recovery was achieved within one week of drug withdrawal in 80.95% of the patients. Overall, 95.83% of the individuals fully recovered after management. CONCLUSIONS Future cases need to describe the long-term follow-up of the individuals. Additionally, FQN-induced myoclonus should include electrodiagnostic studies.
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Affiliation(s)
- Jamir Pitton Rissardo
- Medicine Department, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
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Tuhin MTH, Liang D, Liu F, Aldawod H, Amin TU, Ho JS, Emara R, Patel AD, Felmlee MA, Park MS, Uchizono JA, Alhamadsheh MM. Peripherally restricted transthyretin-based delivery system for probes and therapeutics avoiding opioid-related side effects. Nat Commun 2022; 13:3590. [PMID: 35739116 PMCID: PMC9226319 DOI: 10.1038/s41467-022-31342-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/14/2022] [Indexed: 11/09/2022] Open
Abstract
Several investigations into the sites of action of opioid analgesics have utilized peripherally acting mu-opioid receptor antagonists (PAMORAs), which have been incorrectly assumed to possess limited permeability across the blood-brain barrier. Unfortunately, the poor pharmacokinetic properties of current PAMORAs have resulted in misunderstandings of the role of central nervous system and gastrointestinal tract in precipitating side effects such as opioid-induced constipation. Here, we develop a drug delivery approach for restricting the passage of small molecules across the blood-brain barrier. This allows us to develop naloxone- and oxycodone-based conjugates that display superior potency, peripheral selectivity, pharmacokinetics, and efficacy in rats compared to other clinically used PAMORAs. These probes allow us to demonstrate that the mu-opioid receptors in the central nervous system have a fundamental role in precipitating opioid-induced constipation. Therefore, our conjugates have immediate use as pharmacological probes and potential therapeutic agents for treating constipation and other opioid-related side effects.
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Affiliation(s)
- Md Tariqul Haque Tuhin
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Dengpan Liang
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Fang Liu
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Hala Aldawod
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Toufiq Ul Amin
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Joshua S Ho
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Rasha Emara
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Arjun D Patel
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Melanie A Felmlee
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Miki S Park
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - James A Uchizono
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US
| | - Mamoun M Alhamadsheh
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, 95211, US.
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Scavone C, Mascolo A, Ruggiero R, Sportiello L, Rafaniello C, Berrino L, Capuano A. Quinolones-Induced Musculoskeletal, Neurological, and Psychiatric ADRs: A Pharmacovigilance Study Based on Data From the Italian Spontaneous Reporting System. Front Pharmacol 2020; 11:428. [PMID: 32351386 PMCID: PMC7174713 DOI: 10.3389/fphar.2020.00428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background The use of quinolones has been associated with the development of serious and persistent adverse drug reaction (ADR) mainly affecting muscles, joints and the nervous system. This risk has led the European Medicines Agency (EMA) to endorse some restrictions on the use of this class of antibiotic. Therefore, we performed a study to primary estimate the reporting probability of musculoskeletal, neurological, and psychiatric ADRs among quinolone generations using national data. Methods We retrieved Individual Case Safety Reports (ICSRs) with a quinolone as suspected drug among those reported through the Campania spontaneous reporting system from January 1st, 2001 to April 30th 2019. Moreover, we retrieved national aggregated safety data from the online public report system (RAM system) for the period from January 1st, 2002 to March 31st, 2019. Risk factors were classified as “age greater than 60 years,” “therapeutic indication,” “renal failure,” “organ transplantation,” “use of corticosteroid,” and “history of side effects”. Reporting odds ratio (ROR) was computed to evaluate the reporting probability of musculoskeletal, neurological, or psychiatric events among quinolones generations. Results A total of 87 ICSRs with a quinolone as suspected drug that reported at least one musculoskeletal, neurological, and psychiatric adverse event were identified in the Campania spontaneous reporting system. Forty-nine (56.3%) ICSRs reported risk factors (total risk factors 59). The most reported risk factor was “age greater than 60 years” (69.5%), followed by “therapeutic indication” (16.9%), “renal failure” (5.1%), “organ transplantation” (3.4%), “use of corticosteroid” (3.4%), and “history of side effects” (1.7%). Second-generation quinolones were associated with a lower reporting probability of musculoskeletal (ROR 0.70; 95% CI 0.63–0.79), neurological (ROR 0.81; 95% CI 0.73–0.90), and psychiatric (ROR 0.55; 95% CI 0.44–0.63) ADRs compared to the third generation of quinolones. Conclusions Our findings showed that third-generation quinolones were always associated with a higher reporting probability of musculoskeletal, neurological, and psychiatric ADRs compared to the second generation ones. Moreover, we described risk factors in more than half of our cases suggesting that the inappropriate use of quinolones is a phenomenon that may frequently predispose patients to the occurrence of these ADRs.
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Affiliation(s)
- Cristina Scavone
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
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Waite NM, Johnson MD, Webster NR, Fong IW. Poor Response to Oral Ciprofloxacin in the Treatment of Peritonitis in Patients on Intermittent Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301300110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To assess the clinical value of oral ciprofloxacin in the treatment of peritonitis in an intermittent peritoneal dialysis (IPD) population. Design Open nonrandomized prospective study. Setting Nephrology Peritoneal Dialysis Unit in a tertiary care, teaching hospital of the University of Toronto. Patients Subjects were participants of the IPD program with an acute episode of peritonitis defined as at least two of the following: 1. signs and symptoms of peritonitis, 2. cloudy peritoneal fluid with a white blood cell count of >100!IJl, 3. demonstration of bacteria in peritoneal effluent by gram stain or culture. Ten patients were enrolled in the study, but two were withdrawn because of side effects and growth of a resistant bacteria. Interventions Ciprofloxacin 750 mg po q12h for 2 doses, then 750 mg daily or 500 mg twice daily for 10 days. Main Outcome Measures Efficacy was determined by clinical and microbiological assessment. Cure was defined as resolution of signs and symptoms with eradication of the causative organism. Peritoneal effluent and blood samples were analyzed for ciprofloxacin concentration. Results Ciprofloxacin was effective in treating only one of ten episodes of peritonitis. Seven patients were defined as microbiological failures (persistence or relapse of organisms). The signs and symptoms of peritonitis improved in 2 patients, but the remaining 5 failed clinically. Only Gram-positive organisms were cultured. Conclusions Ciprofloxacin cannot be recommended for the treatment of intermittent peritoneal dialysis related Gram-positive bacterial peritonitis.
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Affiliation(s)
- Nancy M. Waite
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael D. Johnson
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Nancy R. Webster
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ignatius W. Fong
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Paradiso P, Serro AP, Saramago B, Colaço R, Chauhan A. Controlled Release of Antibiotics From Vitamin E–Loaded Silicone-Hydrogel Contact Lenses. J Pharm Sci 2016; 105:1164-72. [DOI: 10.1016/s0022-3549(15)00193-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/12/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
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Lizarraga KJ, Lopez MR, Singer C. Reversible craniocervical dystonia associated with levofloxacin. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2015; 2:10. [PMID: 26788346 PMCID: PMC4710986 DOI: 10.1186/s40734-015-0021-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/19/2015] [Indexed: 11/11/2022]
Abstract
Background Dystonia is a hyperkinetic movement disorder related to dysfunction of inhibitory basal ganglia and cortical circuits. GABA is the major inhibitory neurotransmitter in the central nervous system. Quinolones can rarely produce serious neurologic effects, which have been attributed to impaired inhibition through GABA antagonism. We report a case of reversible craniocervical dystonia associated with oral levofloxacin. Case presentation A 62-year-old man on hemodialysis presented with craniocervical dystonia 3 days after initiation of levofloxacin 500 mg. twice daily. Levofloxacin was discontinued. Seven days later the abnormal movements completely disappeared and did not recur in the following 3 months. Conclusion Levofloxacin should be considered as a rare but potentially reversible trigger of craniocervical dystonia. Older age, renal impairment and high doses of the drug might be risk factors. Electronic supplementary material The online version of this article (doi:10.1186/s40734-015-0021-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karlo J Lizarraga
- Department of Neurology, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, 13th Floor, Miami, FL 33136 USA
| | - Maria R Lopez
- Department of Neurology, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, 13th Floor, Miami, FL 33136 USA
| | - Carlos Singer
- Department of Neurology, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, 13th Floor, Miami, FL 33136 USA
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Abdalla A, Ramly S, Boers P, Casserly L. Ciprofloxacin-associated choreoathetosis in a haemodialysis patient. BMJ Case Rep 2013; 2013:bcr-2013-009293. [PMID: 23605987 DOI: 10.1136/bcr-2013-009293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report describes a case of drug-associated choreoathetosis in a patient receiving ciprofloxacin. A 72-year-old haemodialysis patient presented with a 4-day history of progressive weakness, restlessness and involuntary movements of all limbs. He had been prescribed ciprofloxacin 500 mg twice daily for a lower respiratory tract infection 7 days previously. He had generalised choreoathetosis affecting both upper and lower limbs. The temporal relationship with drug exposure and a dose which was on the upper limit for his renal impairment implicated ciprofloxacin as the culprit. His symptoms completely resolved within 1 week of drug withdrawal and never recurred subsequently.
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Affiliation(s)
- Ahad Abdalla
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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10
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11
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Orofacial Dyskinesia After Moxifloxacin Treatment—A Case With Normal Hepatorenal Function and Review of Literature. Clin Neuropharmacol 2012; 35:292-4. [DOI: 10.1097/wnf.0b013e31826ba0eb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Garhwal R, Shady SF, Ellis EJ, Ellis JY, Leahy CD, McCarthy SP, Crawford KS, Gaines P. Sustained ocular delivery of ciprofloxacin using nanospheres and conventional contact lens materials. Invest Ophthalmol Vis Sci 2012; 53:1341-52. [PMID: 22266514 DOI: 10.1167/iovs.11-8215] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To formulate conventional contact lenses that incorporate nanosphere-encapsulated antibiotic and demonstrate that the lenses provide for sustained antibacterial activity. METHODS A copolymer composed of pullulan and polycaprolactone (PCL) was used to synthesize core-shell nanospheres that encapsulated ciprofloxacin. Bactericidal activity of the nanosphere-encapsulated ciprofloxacin (nanosphere/cipro) was tested by using liquid cultures of either Staphylococcus aureus or Pseudomonas aeruginosa. Nanosphere/cipro was then incorporated into HEMA-based contact lenses that were tested for growth inhibition of S. aureus or P. aeruginosa in liquid cultures inoculated daily with fresh bacteria. Lens designs included thin or thick lenses incorporating nanosphere/cipro and ciprofloxacin-HCl-soaked Acuvue lenses (Acuvue; Johnson & Johnson Vision Care, Inc., Jacksonville, FL). RESULTS Less than 2 μg/mL of nanosphere/cipro effectively inhibited the proliferation of cultures inoculated with 10(7) or 10(8) bacteria/mL of S. aureus and P. aeruginosa, respectively. HEMA-based contact lenses polymerized with nanosphere/cipro were transparent, effectively inhibited the proliferation of greater than 10(7)/mL of bacteria added daily over 3 days of culture, and killed up to 5 × 10(9) total microbes in a single inoculation. A thicker lens design provided additional inhibition of bacterial growth for up to 96 hours. CONCLUSIONS Core-shell nanospheres loaded with an antibiotic can be incorporated into a conventional, transparent contact lens and provide for sustained and effective bactericidal activity and thereby provide a new drug delivery platform for widespread use in treating ocular disorders.
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Affiliation(s)
- Rahul Garhwal
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA
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13
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Stress can affect drug pharmacokinetics via serum/tissues protein binding and blood flow rate alterations. Eur J Drug Metab Pharmacokinet 2011; 37:1-7. [DOI: 10.1007/s13318-011-0077-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 11/22/2011] [Indexed: 11/26/2022]
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14
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Grill MF, Maganti RK. Neurotoxic effects associated with antibiotic use: management considerations. Br J Clin Pharmacol 2011; 72:381-93. [PMID: 21501212 DOI: 10.1111/j.1365-2125.2011.03991.x] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The clinical manifestations of antibiotic-induced neurotoxic effects, the underlying mechanisms and management strategies have been reviewed. PubMed and OVID searches (January 1960-June 2010) were conducted using search terms such as antibiotics, side effects, neurotoxicity and encephalopathy which yielded approximately 300 articles. All relevant case reports, case series, letters and retrospective reviews describing neurotoxic effects and those discussing mechanisms of neurotoxicity were included. Antibiotic-induced neurotoxic side effects can have a myriad of neurologic presentations. Patients with prior central nervous system (CNS) disease, renal insufficiency and advanced age may be particularly vulnerable. Treatment consists of discontinuation of the offending agent, use of antiepileptic drugs in the case of seizures or status epilepticus and haemodialysis in certain cases. The risk of CNS toxicity may be reduced via dosage adjustments in high risk populations. Awareness of the potential neurotoxic clinical manifestations of various antibiotics and high degree of vigilance in critically ill patients is essential in identifying a potentially serious, though reversible complications of antibiotic therapy particularly with the advent of newer antimicrobial agents.
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Affiliation(s)
- Marie F Grill
- University of California San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, 4M62, San Francisco, CA 94110, USA
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15
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Abstract
Quinolones are a class of antibacterial agents for the treatment of several infectious diseases (e.g. urinary and respiratory tract infections). They are used worldwide due to their broad spectrum of activity, high bioavailability and good safety profile. The safety profile varies from quinolone to quinolone. The aim of this article was to review the neurological and psychiatric adverse drug reaction (ADR) profile of quinolones, using a literature search strategy designed to identify case reports and case series. A literature search using PubMed/MEDLINE (from inception to 31 October 2010) was performed to identify case reports and case series related to quinolone-associated neurological and psychiatric ADRs. The search was conducted in two phases: the first phase was the literature search and in the second phase relevant articles were identified through review of the references of the selected articles. Relevant articles were defined as articles referring to adverse events/reactions associated with the use of any quinolone. Abstracts referring to animal studies, clinical trials and observational studies were excluded. Identified case reports were analysed by age group, sex, active substances, dosage, concomitant medication, ambulatory or hospital-based event and seriousness, after Medical Dictionary for Regulatory Activities (MedDRA®) coding. From a total of 828 articles, 83 were identified as referring to nervous system and/or psychiatric disorders induced by quinolones. 145 individual case reports were extracted from the 83 articles. 40.7% of the individual case reports belonged to psychiatric disorders only, whereas 46.9% related to neurological disorders only. Eight (5.5%) individual case reports presented both neurological and psychiatric ADRs. Ciprofloxacin, ofloxacin and pefloxacin were the quinolones with more neurological and psychiatric ADRs reported in the literature. Ciprofloxacin has been extensively used worldwide, which may explain the higher number of reports, while for ofloxacin and pefloxacin, the number of reports may be over-representative. A total of 232 ADRs were identified from the selected articles, with 206 of these related to psychiatric and/or neurological ADRs. The other 26 were related to other body systems but were reported together with the reactions of interest. Mania, insomnia, acute psychosis and delirium were the most frequently reported psychiatric adverse events; grand mal convulsion, confusional state, convulsions and myoclonus were the most frequently reported neurological adverse events. Several aspects should be taken into account in the development of CNS adverse effects, such as the pharmacokinetics of quinolones, chemical structure and quinolone uptake in the brain. These events may affect not only susceptible patients but also 'healthy' patients.
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Affiliation(s)
- Ana M Tomé
- Medical Department, Grupo Tecnimede, Sintra, Portugal.
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Abstract
Nervous system toxicity with current antituberculosis pharmacotherapy is relatively uncommon, although the frequency of the usage of antituberculosis therapy requires that physicians be aware of such toxicity. Antituberculosis therapy manifests both central and peripheral nervous system effects, which may compromise patient compliance. Among the traditional forms of first-line antituberculosis therapy, isoniazid is most often associated with nervous system effects, most prominently peripheral neuropathy, psychosis and seizures. Adverse events are reported with other antituberculosis therapies, the most prominent being optic neuropathy with ethambutol and ototoxicity and neuromuscular blockade with aminoglycosides. The second-line agent with the most adverse effects is cycloserine, with psychosis and seizures, the psychosis in particular limiting its usage. Fluoroquinolones are rare causes of seizures and delirium. Newer forms of therapy are under development, but to date no significant neurotoxicity is documented with these agents. Future needs include the development of surveillance mechanisms to increase recognition of nervous system toxicities. It is also hoped that the development of new pharmacogenomic assays will help with the identification of patients at risk for these toxicities.
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Affiliation(s)
- Joseph S Kass
- Baylor College of Medicine, Houston, Texas 77030, USA.
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A seizure attributed to ofloxacine in a woman undergoing detoxification for alcohol dependence. Case Rep Med 2010; 2009:705635. [PMID: 20145722 PMCID: PMC2817391 DOI: 10.1155/2009/705635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 12/02/2009] [Indexed: 11/17/2022] Open
Abstract
Objective. To report one case of seizure following administration of ofloxacin. Case Summary. A 38-year-old woman with alcohol dependence but no prior history of seizure disorder admitted in our inpatient alcohol detoxification program was prescribed ofloxacin four days after admission for a lower urinary tract infection. She was currently prescribed diazepam 30 mg per day. This treatment was continued without modification following admission. Forty eight hours after starting ofloxacin and after receiving five doses of oral ofloxacin, the patient experienced a seizure. Ofloxacin treatment was stopped and no further seizures occurred. Neurological examination of the patient, laboratory tests, computerized tomography with contrast enhancement and electroencephalography did not detect any abnormalities. Up to the last consultation, six months after admission, the patient has reported no recurrence of the seizure. Discussion. Quinolone antibiotics vary in their ability to induce seizures, with ofloxacin having one of the least potentials. In the present case, the seizure could be attributed in all probability to taking ofloxacin; since she had no previous history of seizures, she did not present an alcohol withdrawal syndrome, benzodiazepine treatment was not modified, the seizure occurred 48 h after taking ofloxacin, but seven days after stopping drinking, no alternative aetiologies for the seizure could be identified and no seizure recurrence was reported over the following seven months. Of reported cases of seizures in patients treated with fluoroquinolones, none concerned patients with alcohol dependence or patients treated with benzodiazepines. Conclusions. The present case alerts us to the possibility that seizures may occur in alcohol dependent patients treated with benzodiazepines who concomitantly prescribed a fluoroquinolone. These widely-used antibiotics should thus be prescribed with caution to patients undergoing detoxification for alcohol dependence, particularly if they are also taking benzodiazepines, irrespective of whether they have a previous history of seizures or not.
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Lemaire-Hurtel AS, Gras-Champel V, Hary L, Masmoudi K, Massy Z, Andréjak M. [Recommended dosage adaptation based on renal function is not always sufficient to avoid betalactam antibiotics side effects]. Nephrol Ther 2008; 5:144-8. [PMID: 19071080 DOI: 10.1016/j.nephro.2008.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 09/17/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
The potential neurotoxicity of betalactam antibiotics are well-known and is frequently associated with drug accumulation in patients with renal failure since these antibiotics are eliminated mostly by kidneys. The regional center of pharmacovigilance of Amiens has collected since 10 years, 20 notifications of neurotoxicity induced by betalactam antibiotics. The series included eight women and 12 men. Mean age was 65 years (26-84). The drug accumulation hypothesis was strengthened in nine cases by assays of plasma levels residual concentrations. In 17 cases, betalactam antibiotics dosage was adapted to creatinin clearance in accordance to the Summary of the Product Characteristics' (SPC) recommendations. For several drugs, no adaptation to renal function was proposed by SPC. Dosage adaptation based only on renal function as it's recommended is not always efficient to avoid neurological side effects.
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Affiliation(s)
- Anne-Sophie Lemaire-Hurtel
- Service de pharmacologie clinique, groupe hospitalier Sud, CHU d'Amiens, Inserm, ERI 12, faculté de pharmacie, 80000 Amiens, France.
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Abstract
We describe an 84-year-old man with an unusual clinical presentation of palatal tremor in association with ciprofloxacin treatment. The patient had rhythmical movements not only of the soft palate but also of the face and trunk. Complete resolution of the symptoms occurred 2 days after discontinuation of ciprofloxacin and administration of sodium valproate. This is the first reported case of palatal tremor secondary to the use of ciprofloxacin.
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Affiliation(s)
- Yuk-Fai Cheung
- Department of Medicine, Neurology Division, Queen Elizabeth Hospital, Hong Kong, China.
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20
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Abstract
OBJECTIVE To survey cases of fluoroquinolone-associated adverse events that included peripheral nervous system (PNS) symptoms posted on Internet Web sites. METHODS Cases were obtained with the assistance of members of Web sites formed by people sustaining fluoroquinolone-related events. Information obtained met the standards of MedWatch, and each reported case was assessed using the Naranjo probability scale. RESULTS In contrast to previous reports suggesting that fluoroquinolone-associated PNS events are mild and short-term, 36 of the 45 cases reported severe events that typically involved multiple organ systems. Although many newer cases are still evolving, symptoms had lasted more than three months in 71% of cases and more than one year in 58%. Onset of adverse events was usually rapid, with 15 (33%) events beginning within 24 hours of initiating treatment, 26 (58%) within 72 hours, and 38 (84%) within one week. Sixty courses of fluoroquinolones were prescribed: levofloxacin (n = 33 cases), ciprofloxacin (n = 11), ofloxacin (n = 6), lomefloxacin (n = 1), trovafloxacin (n = 1); in eight cases the same antibiotic was prescribed twice. CONCLUSIONS These cases suggest a possible association between fluoroquinolone antibiotics and severe, long-term adverse effects involving the PNS as well as other organ systems. The severity of these cases may reflect a different population than typically reported to drug companies or MedWatch, which often originate from healthcare providers. In contrast, Internet Web sites may provide a forum for patients experiencing adverse effects that have not resolved promptly. Further study is warranted. Meanwhile the occurrence of PNS symptoms during fluoroquinolone therapy should prompt immediate discontinuation of the agent used.
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Affiliation(s)
- J S Cohen
- Departments of Family and Preventive Medicine, and Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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Abstract
OBJECTIVE To report two cases of seizures following administration of levofoxacin and ciprofloxacin. CASE SUMMARY A 75-year-old white woman admitted to the hospital was prescribed levofloxacin for ischemic toes. After receiving three doses of oral levofloxacin, the patient experienced a seizure. One month later, the patient was rechallenged with ciprofloxacin and again experienced a seizure. The patient was hypomagnesemic and had elevated serum creatinine at the time of both seizures, and was hyponatremic during the second seizure. A 74-year-old white woman admitted to the hospital was prescribed levofloxacin for bacterial pneumonia. After five doses, the patient experienced a seizure. The woman had no electrolyte imbalances at the time of the seizure and no history of a seizure disorder. DISCUSSION Quinolone antibiotics vary in their ability to induce seizures, with trovafloxacin having the greatest potential and levofloxacin possibly having the least potential. Neither patient had a history of a previous seizure disorder. Electrolyte imbalances are common with previous reports of fluoroquinolone-induced seizures. CONCLUSIONS Although levofloxacin monotherapy has not been implicated in inducing seizures, it appears to be the causative agent in the second case. In the first case, the quinolones may have been a necessary, but not sufficient, cause in a patient with electrolyte abnormalities. Risk factors for fluoroquinolone-induced seizures may Include seizure history, electrolyte imbalances,dose unadjusted for renal insufficiency, and concomitant treatment with agents that lower the seizure threshold.
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Affiliation(s)
- J M Kushner
- School of Pharmacy, Campbell University, Buies Creek, NC, USA
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Postelnick M, Halbur SR. Pharmacologic considerations with antimicrobials used in oncology. Cancer Treat Res 1998; 96:247-82. [PMID: 9711403 DOI: 10.1007/978-0-585-38152-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Postelnick
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA
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Abstract
Ciprofloxacin, one of the fluoroquinolone antibiotics, has become one of the most widely prescribed antimicrobial agents. It is generally well tolerated with a low incidence of side effects, which are mild in nature. There is a distinct incidence of neuropsychiatric adverse effects, which include psychotic reactions. We describe a case of a woman who experienced an acute psychosis secondary to ciprofloxacin administration, which resolved on cessation of therapy. All urologists should be aware of this problem and be familiar with the recommendations for ciprofloxacin use in patients with underlying neuropsychiatric problems.
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Affiliation(s)
- J P Mulhall
- Division of Urology, University of Connecticut School of Medicine, Farmington, USA
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Rfidah EI, Findlay CA, Beattie TJ. Reversible encephalopathy after intravenous ciprofloxacin therapy. Pediatr Nephrol 1995; 9:250-1. [PMID: 7794728 DOI: 10.1007/bf00860763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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