Caution! Fluoroquinolone antibiotics may cause peripheral neuropathy: JAMA

United Kingdom: Many authorities in the past including the US Food and Drug Administration (FDA) have issued warnings on the use of fluoroquinolones owing to risks involved with its use such as peripheral neuropathy, tendon rupture, and its adverse effects on the central nervous system (CNS). Along the same lines, a new study has found that oral fluoroquinolone therapy is associated with an increased risk of incident peripheral neuropathy.

Based on the findings of the study, published in the journal JAMA Neurology, the authors have cautioned that health care professionals should be wary of the potential risk of peripheral neuropathy when prescribing fluoroquinolone antibiotics.

Peripheral neuropathy has been associated with systemic fluoroquinolone exposure, but the risk has not been studied properly. Daniel Morales, Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom, and colleagues conducted the study to calculate relative and absolute risk estimates for the association of fluoroquinolone exposure with peripheral neuropathy and to examine how risk may be affected by the timing of fluoroquinolone exposure and by other risk factors.

The researchers used patient's data from The Health Improvement Network database, a large primary care population database in the United Kingdom, from January 1, 1999, to December 31, 2015. The cohort consisted of 1 338 900 adults issued 1 or more prescriptions of fluoroquinolone (34.3%) or amoxicillin-clavulanate (65.7%) antibiotics.

In total, 5357 patients with incident peripheral neuropathy (mean [SD] age, 65.6 [14.7] years; 2809 women [52.4%]) were matched to 17 285 controls (mean [SD] age, 64.4 [15.2] years; 9485 women [54.9%]) without diabetes.

Also Read: Fluoroquinolones can cause serious heart damage, FDA warns

Key findings of the study include:

• Current oral fluoroquinolone exposure was associated with an increased relative incidence of peripheral neuropathy compared with no exposure.


• Risk increased by approximately 3% for each additional day of current fluoroquinolone exposure and persisted for up to 180 days following exposure.


• No significant increased risk was observed with oral amoxicillin-clavulanate exposure.


• The absolute risk with current oral fluoroquinolone exposure was 2.4 per 10 000 patients per year of current use.


• The number needed to harm for a 10-day course was 152 083 patients and was greatest among men and among patients older than 60 years.

Also Read: Fluoroquinolones associated with risk of Achilles tendon rupture, finds new study

"Peripheral neuropathies are quite common, especially among the elderly and in population-based studies, such that after 60 years of age more than 6% of the population will have developed neuropathy." Nathan P. Staff and P. James B. Dyck, from Mayo Clinic, Rochester, Minnesota, wrote in an accompanying editorial. "Drug-induced peripheral neuropathies are also common, especially in the setting of neurotoxic chemotherapy for cancer but may also be seen in the setting of antibiotics (eg, nitrofurantoin, metronidazole), cardiac (amiodarone), and epilepsy (phenytoin) medications."

"The results of the present study suggested that oral fluoroquinolone therapy was associated with an increased risk of incident peripheral neuropathy that may depend on the timing of the exposure and the cumulative dose," concluded the study authors.

For detailed study log on to doi:10.1001/jamaneurol.2019.0887