Side Effects

An article in the September 10th New York Times warned its readers against serious side effects of fluoroquinolones, particularly levofloxacin. I’m not sure why, but articles like this always make me sad. It’s not that the article said anything that’s not true. Fluoroquinolones do have side effects and they are overused. We said so ourselves in a recent article in The Medical Letter on Drugs for Urinary Tract Infections, in which we advised against their first-line use for treatment of acute uncomplicated cystitis, but advocated their use for acute pyelonephritis (Medical Letter 2012; 54:57).

I guess one thing that makes me sad is that the public doesn’t seem to be able to accept the fact that all drugs have side effects. In the current climate, I doubt that the FDA would approve penicillin, which can kill people in seconds, or even aspirin, which indisputably has made some people bleed to death. Another saddening thing is that the media seems unable (or unwilling) to make a distinction between associations and causes. So if a man takes 2 doses of levofloxacin, as described in the New York Times, and develops a paragraph full of disabling symptoms, or if a building falls on him, it must have been the drug that did it.

Fluoroquinolones are useful drugs. I looked back at our article on Drugs for Bacterial Infections (Treatment Guidelines 2010; 8:43) and found that we recommended their use for some patients with community-acquired pneumonia, pyelonephritis, prostatitis, intra-abdominal infections and sepsis, among other conditions. They do, of course, cause adverse effects including GI and CNS symptoms, and rarely, tendon rupture and Stevens-Johnson syndrome.  Every drug has risks, but if used appropriately only for serious infections, the benefits of using a fluoroquinolone such as levofloxacin will generally outweigh its risks.

I feel better now, as long as I don’t think about how many more people read the New York Times than will ever read this.

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